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Q1: If I am a provider in New Jersey and would like to appeal the payment amount on a claim, does the state specify a form?
The appeal process relating to questions of utilization review, experimental/investigational and medical necessity are addressed in the plan booklet. For other payment appeals the state of New Jersey enacted the Provider Independent Claims Payment Arbitration (PICPA) process, requiring use of a carrier-specific Health Care Provider Application to Appeal a Claim Determination form (DOBICAPPCAR 10/10). Company-specific Provider Independent Claim Payment Arbitration (PICPA) forms are below. Please select the link that applies to the carrier:
Q2: If I am a provider in New Jersey, how do I learn more about claim adjudication?
Please contact the following email link to obtain additional information: adj.meth@AmericanNational.com
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