New Jersey § 26:2h-12

§ 26:2h-12.

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 facility licensed pursuant to P.L.1971, c. 136 ( C.26:2H-1 et seq. ) is responsible for filing all claims for third party payment, including claims filed

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

by the health care facility 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 health care facility's patient, the

health care facility 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 the patient's benefits to the health care facility, the health care facility 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 health care facility 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 health care facility 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 length of delay in filing the claim, the good faith

use of information provided by the patient to the health care facility 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 health care facility which 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 facility which 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 health care facility fails to submit a claim. The penalty shall be sued for and collected by the Department of Health pursuant to the “Penalty Enforcement Law of 1999,” P.L.1999, c. 274 ( C.2A:58-10 et seq. ).