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New Jersey Workers’ Comp eBilling rules adopted

by | Jun 13, 2018

The New Jersey Department of Labor and Workforce Development Division of Workers’ Compensation (the department), recently adopted regulations to implement prior electronic medical billing (eBilling) legislation – requiring eBilling effective October 2019. The rules also adopt a 60-day payment timeframe for complete electronic medical bills, which the prior legislation also required.

All workers’ comp providers and billers (with some listed exceptions) are required to submit complete electronic bills using the X12 837 standard (the HIPAA standard for medical billing) and employers and carriers are required to accept and acknowledge receipt of those bills. Notably, employers and carriers may exchange electronic data and establish payment deadlines through contracts or agreements with providers or their billing representatives in a non-prescribed format or timeline, independent of the adopted standard.

The new rules do not provide many details, and they leave pharmacy standards unaddressed. In response to several stakeholders concerns with this the department stated, “It is the department's position that adoption of the ANSI X12 837 National Standard will suffice as a minimum guideline for submission of electronic medical bills in workers' compensation. To the degree that there are enhanced industry standards, those impacted by the Act and the implementing rules are free to utilize those enhanced standards. However, the enhanced standards will not be enforced by the Division of Workers' Compensation.”

The adopted rules, along with responses to stakeholder comments, can be viewed here. For context, the original legislation requiring the rules can be read here. Should you have any questions on this or other public policy development issues, please contact our Government Affairs team at AskGovtAffairs@optum.com.