Unexpected out-of-network charges continue to pose a problem for health care
consumers in New Jersey. On June 1, 2018, the State of New Jersey passed
legislation to enhance consumer protections, create a system to resolve certain
health care billing disputes, and contain rising health care costs due to
out-of-network charges. You can review the Out-of-Network Consumer Protection, Transparency, Cost Containment and
Accountability Act to learn more.
Claims that fall under the new law
To comply with this new law, AmeriHealth New Jersey is working to implement
notification requirements into our claims processing system. In the interim,
New Jersey-based providers will be notified by letter when claims are
identified as inadvertent and/or involuntary out-of-network treatment. If the
claim is identified as such, the patient responsibility is limited to the
in-network cost-share. The letter will contain the following information:
- Claim number
- Date of service
- Member name
- Member ID
- Provider name
- Provider ID
The letter will also contain instructions on how to initiate negotiation if
you choose not to accept AmeriHealth New Jersey’s remittance as payment
in full.
Once the system requirements are implemented, this notification will be
included on the Provider Explanation of Benefits and letters to address the
issue will not be mailed.
More information
If you have additional questions related to this new law, please call the
AmeriHealth New Jersey Provider Network Operations Department at
609-662-2353.