This is the last piece of the 2013 regulations, and had been twice postponed over the past two years. There will be a 60 day comment period.
Some key elements include:
• Insurers shall only require a one-level appeal process.
• Standardized appeal forms established by the Department shall be utilized.
• Appeals are broken down into two types- Pre-service and Post-service, with set time limits for each.
“This proposal has been long overdue,” says Jeff Shanton, Chair of Government Affairs Committee for NJAASC. “Previously everything was left to the whim of the carrier; from special appeal forms, to how many appeals were required, to the time frame for said appeals. Literally every carrier could require their own paperwork and had their own rules, which led to confusion amongst the provider community
“We applaud the Department for this proposal and the standardization that comes with it. Medical necessity should be the determining factor in treatment and payment of a PIP procedure, not the paperwork and the crossing of Ts and dotting of Is,” said Mr. Shanton.
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