Electronic Medical Bills for Workers' Compensation Claims

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.

The NJ Department of Labor and Workforce Development (Department) is proposing a new rule at N.J.A.C. 12:235-1.9 in order to implement P.L. 2016, c. 64 (Act), which requires that the Department adopt "rules and regulations," which require that: (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 within section 4 of the Act, shall submit complete electronic medical bills for payment on standardized electronic forms following the guidelines established by the Department pursuant to the Act.

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).

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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). 

For over 4 decades theLaw Offices of Jon L Gelman  1.973.696.7900  jon@gelmans.com  has been representing injured workers and their families who have suffered occupational accidents and illnesses.