Pursuant to the New Jersey Administrative Code, N.J.A.C. 11:3-4.1 et seq., the New Jersey Department of Banking and Insurance (“NJDOBI”) has published standard courses of treatment, identified as Care Paths, for certain identified Injuries and diagnostic testing. All services must be medically necessary, clinically supported by information provided by claimant’s treating health care provider and related to the injuries sustained in the accident. The Care Paths provide for the evaluation of treatment at certain intervals called “Decision Points.” where claimant’s treating health care provider must provide certain information about further treatment the health care provider intends to perform. This is called Decision Point Review. Please see below for the applicable plan based on Date of Service.
Date of Service Prior to 4/17/2017
Date of Service from 4/17/2017 to 08/31/2017
Date of Service on or after 11/15/2017
For non-emergency benefits, certain goods and services may be secured through the Association’s designated Voluntary Utilization Network (“VUN”): All of the VUN partners meet the requirements of N.J.A.C. 11:3-4.8. These VUN partners provide services outlined in the Association’s DPR Plan and offer convenient locations throughout the State. Utilizing the VUN maximizes the benefit dollars available for claimant’s treatment. To obtain information regarding the available Voluntary Utilization Network services, click here.
Medical bills can be mailed to the Association at 233 Mt. Airy Road, Basking Ridge, NJ 07920 or sent electronically. For more information on E-Billing please click here.
All Medical Bills are paid, delayed or denied within 60 days of receipt. Status inquiries for bills over 30 days old and requests for EOR and check copies can be faxed to 908-382-7154 or emailed to BillInfo@njguaranty.org. Please be sure to include the claim number, claimant name, date of service and provider name to ensure accurate and timely processing of the request.
To inquire about the process for filing an appeal or to follow up with the status of an existing appeal, please fax your request to 908-382-7154 or email to BillInfo@njguaranty.org. Please be sure to include the claim number, claimant name, date of service and provider name to ensure accurate and timely processing of the request.
To inquire if a claim is still open, please fax your request to 908-382-7154. Please be sure to include the claim number and claimant number on your correspondence.