The State of NJ has recently adopted an "electronic medical bill" process. N.J.S.A. 34:15-144, P.L 2016, c. 64. On October 16, 2017, Regulations were proposed to implement the Statute. Public Hearing will be held on Tuesday, November 14, 2017, 10:00 A.M. to 12:00 Noon. The deadline for written comments is December 15, 2017.
N.J.A.C. 12:235-1.9 Electronic medical bills for workers' compensation claims
(a) All workers' compensation healthcare providers, their billing representative, or any company that has purchased the
right to pursue their bill, with the exception of those set forth at N.J.S.A. 34:15-146, shall submit complete electronic
medical bills for payment using the American National Standards Institute (ANSI) Accredited Standards Committee
(ASC) X12 837 National Standard.
(b) Employers, workers' compensation insurance carriers of employers, or workers' compensation third-party
administrators shall accept electronic medical bills submitted for the payment of medical services under (a) above.
(c) Medical information submitted on electronic medical bills for payment of medical services shall be confidential,
pursuant to the "Workers' Compensation Medical Information Confidentiality Act," sections 5 through 9 of P.L. 2001,
c. 326 (N.J.S.A. 34:15-128.1 et seq.).
(d) Employers, workers' compensation insurance carriers of employers, or workers' compensation third-party
administrators shall acknowledge receipt of a complete electronic medical bill to the party that sent the complete
electronic medical bill under (a) above.
(e) Payment for a complete electronic medical bill deemed by the employer, workers' compensation insurance carrier, or
the workers' compensation third-party administrator to be compensable shall be paid within 60 days or less.
(f) Employers, workers' compensation insurance carriers for the employer, and their third-party administrators may
exchange electronic data and establish payment deadlines through PPO or IPA contracts or agreements with healthcare
providers or their billing representatives in a non-prescribed format or timeline, independent of the American National
Standards Institute (ANSI) Accredited Standards Committee (ASC) X12 837 National Standard.
Source: 49 N.J.R. 3419(a)
Additional reference: Gelman, Jon L, Workers Compensation Law, 38 NJPRAC 12.12.5 (In Press -Thomson-Reuters 2018).
Jon L. Gelman of Wayne NJ is the author of NJ Workers’ Compensation Law (West-Thomson-Reuters) and co-author of the national treatise, Modern Workers’ Compensation Law (West-Thomson-Reuters).