NJ State Bill S-2137 Electronic medical bills for Automobile Insurance Claims effective September 1,2019
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DATED: DECEMBER 14, 2017
The Senate Commerce Committee reports favorably a Senate Committee Substitute for Senate Bill No. 2137.
This substitute bill concerns the electronic submission of certain automobile insurance claims. Specifically, the substitute provides that:
(1) all healthcare providers or their billing representative must submit electronic bills for payment completed on standardized forms following the guidelines established by the bill;
(2) insurance carriers or their third-party administrators must accept electronic bills and comply with the guidelines;
(3) confidentiality of medical information submitted on electronic bills for payment of medical services must be maintained;
(4) insurance carriers or their third-party administrators must acknowledge receipt of a complete electronic medical bill to the party that sent the complete electronic medical bill in compliance with the guidelines; and
(5) payments for a complete electronic medical bill deemed compensable by the insurance carrier be made in accordance with subsection g. of section 5 of P.L.1972, c.70 (C.39:6A-5), provided, however, that insurance carriers or their third party administrators may establish shorter payment deadlines through contracts or agreements with health care providers or their billing representatives in a non-prescribed format or timeline.
Pursuant to the substitute bill, “complete electronic medical bill” means a medical bill that meets all of the following criteria: (1) it is submitted in the correct uniform billing format, with the correct uniform billing code sets, transmitted in compliance with the guidelines; (2) the bill and electronic attachments provide all information required under the guidelines established by the bill; and (3) the health care provider or its billing representative has provided all information that the insurance carrier or its third party administrator requested.
“Guidelines” means the current version of the ASC X12 005010 format.
The bill also excludes from its provision any provider that:
(1) submits less than 25 medical bills per month to insurance carriers or third-party administrators;
(2) furnishes services only outside of the United States;
(3) experiences a disruption in electricity and communication connections that are beyond its control; or
(4) demonstrates that a specific and unusual circumstance exists that precludes submission of electronic bills.
As reported by the committee today, the Senate Committee Substitute for Senate Bill No. 2137 is identical to the Assembly Substitute for Assembly Bill No. 3402 as amended and reported by the committee today.