Skip to main content
Medclaim Services Logo

Menu

Free Billing Audit

Locations

Medical Billing Services in New Jersey

New Jersey practices bill a public program that combines Medicaid, CHIP and expansion populations, auto injuries under a state Personal Injury Protection fee schedule, and out-of-network services under a state arbitration law, all overseen by different agencies. We bill remotely for New Jersey practices and keep each payer on its own rules.

  • NJ FamilyCare managed care organization claims
  • PIP auto claims billed under the Automobile Medical Fee Schedule
  • Out-of-network disputes taken to state arbitration where eligible
Request a Free Billing Audit

Personal Injury Protection and the auto fee schedule

Car insurance is required in New Jersey, and its Personal Injury Protection coverage pays the injured person's medical expenses no matter who caused the accident, which is why it is called no-fault coverage. Providers bill PIP claims under the Automobile Medical Fee Schedule published by DOBI in N.J.A.C. 11:3-29.

PIP coverage limits and fee schedule amounts are set by policy and regulation and change over time, so we work from the current schedule and the patient's policy details rather than fixed figures.

Official sources: NJ Department of Banking and Insurance: auto insurance buyer's guide (external site), NJ DOBI: PIP information for health care providers (external site)

NJ FamilyCare and its managed care organizations

NJ FamilyCare is the state's public health coverage program, bringing together Medicaid, the Children's Health Insurance Program and the Medicaid expansion group. Most NJ FamilyCare beneficiaries are enrolled in managed care, so a managed care organization, not the state directly, is usually responsible for their coverage.

Official source: NJ Division of Medical Assistance and Health Services: about DMAHS (external site)

Practices we typically see in New Jersey

New Jersey practices typically bill Novitas Solutions for traditional Medicare, NJ FamilyCare managed care organizations for most Medicaid and CHIP patients, and auto insurers under DOBI's PIP fee schedule for accident cases.

Insurance regulation and out-of-network arbitration in New Jersey

The Department of Banking and Insurance (DOBI) regulates New Jersey's insurance industry, including life and health insurers and managed care plans. New Jersey's Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act created an arbitration process for out-of-network billing disputes over inadvertent and emergency or urgent services.

Workers' compensation is administered by the Division of Workers' Compensation in the Department of Labor and Workforce Development, under the state Workers' Compensation Law, which covers payment of injured workers' medical expenses.

Official sources: NJ Department of Banking and Insurance: about the department (external site), NJ DOBI: out-of-network consumer protection (external site), NJ Division of Workers' Compensation (external site)

How remote billing works for practices in New Jersey

Claims, PIP files and disputes are all managed remotely through your systems and payer portals. Access is granted by your practice through its own user accounts.

  1. Step 1: Match FamilyCare members to their MCO

    Each NJ FamilyCare patient's managed care organization is confirmed before the visit.

  2. Step 2: Open a PIP file for accident cases

    Auto injury visits are billed to the auto insurer under the Automobile Medical Fee Schedule.

  3. Step 3: Route work injuries separately

    Workers' comp claims are billed to the employer's carrier under state workers' comp rules.

  4. Step 4: Prepare out-of-network arbitration

    Eligible out-of-network payment disputes are documented for the state arbitration process.

Official sources for New Jersey

Rules change. These are the agencies and contractors we check for the current requirements.

Frequently asked questions

Which Medicare contractor covers New Jersey?

Novitas Solutions, the Medicare Administrative Contractor for Jurisdiction L, which also covers Pennsylvania, Delaware, Maryland and the District of Columbia.

Official source: CMS: A/B MAC Jurisdiction L (Novitas Solutions) (external site)

How do we bill an auto accident patient in New Jersey?

To the auto insurer's Personal Injury Protection coverage, under DOBI's Automobile Medical Fee Schedule, rather than the patient's health plan first.

Official source: NJ DOBI: PIP information for health care providers (external site)

What is NJ FamilyCare?

New Jersey's public coverage program, which brings Medicaid, CHIP and the expansion group together. Most members are in managed care, so claims usually go to their MCO.

Official source: NJ Division of Medical Assistance and Health Services: about DMAHS (external site)

Can out-of-network payment disputes go to arbitration in New Jersey?

For inadvertent and emergency or urgent out-of-network services, yes, under the state's out-of-network consumer protection law.

Official source: NJ DOBI: out-of-network consumer protection (external site)

Does a remote billing team work for New Jersey PIP claims?

PIP claims are submitted to the auto insurer with the required documentation, which a remote team can manage. PIP billing can be part of your engagement alongside health plan claims.

Related services and nearby states

See all locations

Billing PIP and NJ FamilyCare in one practice?

Talk to us about running auto, Medicaid and out-of-network claims on their own rules, or start with a free billing audit.

Request a Free Billing Audit