Information regarding...

• Active medical malpractice insurers
• Office for e-HIT (Electronic Health Information Technology)
• Health Benefits Prompt Pay Rule
• Managed Care
• PIP Information for Health Care Providers
• MIIX Insurance Co.

• Office for e-HIT
• HINT-HIPAA Consensus Guides for electronic filing of health care claims by providers, payers and clearinghouses
• NJ's Strategic HIPAA/Healthcare Organization and Regional Effort (NJSHORE)
• Transaction and Code Sets
• Electronic Processing of Health Care Claims
• Privacy
• Security and Testing Certification

• Important Information for Providers
• Frequently Asked Questions
• Prompt Pay Regulations: N.J.A.C. 11:22-1.1
• Recent Changes in Health Care Claims Handling, Prior Authorization and Utilization Management Appeals
• Application to Appeal a Claims Payment Determination
(MS Word)
• Consent to Representation in Appeals of Utilization Management Determinations and Authorization for Release of Medical Records in UM Appeals and Independent Arbitration of Claims (MS Word)
• Selected Arbitration Decisions
  
  Please Note: *Amendments to the statutes regarding the prompt payment of claims became effective on July 11, 2006, and the Department is working to revise the existing prompt payment regulations.  The Department has issued bulletins to address certain topics in the interim, and health care providers are encouraged to review these.  In addition, health care providers may want to review Provider Rights and Responsibilities with respect to the right to appeal a claims payment matter, even if the health care provider is not part of a network.

• NJ Universal Physician Application
• NJ Physician Recredentialing Application
• Provider Rights and Responsibilities
• How to Appeal a UM Decision
• Consent to Representation in Appeals of Utilization Management Determinations and Authorization for Release of Medical Records in UM Appeals and Independent Arbitration of Claims
  • Instructions (PDF)
• Notice of Intent to File a UM Appeal
  • Stage 1; Instructions (PDF)
  • Stage 2; Instructions (PDF)
  • Stage 3 (IHCAP); Instructions (PDF)
• More information

• Insolvency Information