New Jersey § 45:1-10

§ 45:1-10.

Effective 12 months after the adoption of regulations establishing standard health

care enrollment and claim forms by the Commissioner of Banking and Insurance pursuant

to section 1 of P.L.1999, c. 154 ( C.17B:30-23 ), a health care professional licensed pursuant to Title 45 of the Revised Statutes

is responsible for filing all claims for third party payment, including claims filed

on behalf of the licensed professional's patient for any health care service provided

by the licensed professional that is eligible for third party payment, except that

at the patient's option, the patient may file the claim for third party payment. a. In the case of a claim filed on behalf of the professional's patient, the professional

shall file the claim within 60 days of the last date of service for a course of treatment,

on the standard claim form adopted by the Commissioner of Banking and Insurance pursuant

to section 1 of P.L.1999, c. 154 ( C.17B:30-23 ). b. In the case of a claim in which the patient has assigned his benefits to the professional,

the professional shall file the claim within 180 days of the last date of service

for a course of treatment, on the standard claim form adopted by the Commissioner

of Banking and Insurance pursuant to section 1 of P.L.1999, c. 154 ( C.17B:30-23 ). If the professional does not file the claim within 180 days of the last date of

service for a course of treatment, the third party payer shall reserve the right to

deny payment of the claim, in accordance with regulations established by the Commissioner

of Banking and Insurance, and the professional shall be prohibited from seeking any

payment directly from the patient. (1) In establishing the standards for denial of payment, the Commissioner of Banking

and Insurance shall consider the good faith use of information provided by the patient

to the professional with respect to the identity of the patient's third party payer,

delays in filing a claim related to coordination of benefits between third party payers

and any other factors the commissioner deems appropriate, and, accordingly, shall

define specific instances where the sanctions permitted pursuant to this subsection

shall not apply. (2) A professional who fails to file a claim within 180 days and whose claim for payment

has been denied by the third party payer in accordance with this subsection may, in

the discretion of a judge of the Superior Court, be permitted to refile the claim

if the third party payer has not been substantially prejudiced thereby. Application to the court for permission to refile a claim shall be made within 14

days of notification of denial of payment and shall be made upon motion based upon

affidavits showing sufficient reasons for the failure to file the claim with the third

party payer within 180 days. c. The provisions of this section shall not apply to any claims filed pursuant to

P.L.1972, c. 70 ( C.39:6A-1 et seq. ). d. A health care professional who violates the provisions of subsection a. of this

section may be subject to a civil penalty of $250 for each violation plus $50 for

each day after the 60th day that the provider fails to submit a claim. The penalty shall be sued for and collected by the Division of Consumer Affairs

in the Department of Law and Public Safety pursuant to “the penalty enforcement law,” N.J.S.2A:58-1 et seq.