The NJ Department of Labor and Workplace Development [DLWD] has adopted Rules regarding electronic medical billing in workers' compensation matter that do not follow the International Association of Industrial Accident Boards and Commission's [IAIABC] Model Rule. The NJ DLWD has decided to accept the ASC X12 837 [ASC] standard only.
NJ adopted an "electronic medical bill" process for workers compensation claims by statute, The act does not apply to any provider who submits less than 25 medical bills per year. N.J.S.A. 34:15-143-144/ Gelman, Jon L, Workers’ Compensation Law, 38 NJPRAC 12.12.50 (Thomson-Reuters 2018).
The DLWD reasoned that the ASC standard for electronic medical bills was developed by the American National Standards Institue (ANSI) Accredited Standards Committee National Standards. It is a less complicated and complex than the multiple code sets defined by the IAIABC's Model Rule which includes: CDT-4 Codes; Diagnostic Related Group (DRG); HCPCS-CMS and the ICD-9 CM Codes.
The NJ DLWD stated that NJ Judges of Compensation preside over contested work-related claims and these hearing officials have not "overseen" or in any way, been involved with the mechanic of medical bill submissions. Therefore, the enhanced standard of the IAIABC Rule will not be enforced by the NJ Division of Workers' Compensation.
2018 NJ REG TEXT 471466, 50 N.J.R. 1280(a), NJAC 12:35-1.9 effective May 21, 2018.
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