Arbitration is a written request for dispute resolution.
If a provider or hospital disagrees with a decision by HCS or the claimant’s insurer regarding the noncertification of medical treatment or reimbursement in a PIP matter, arbitration can be requested.
In accordance with New Jersey PIP regulations, the provider or hospital is required to follow the appeals process prior to filing for arbitration. Accordingly, network providers must submit appeals to HCS for reconsideration prior to filing an arbitration. If the decision rendered as a result of the internal appeals process is considered unsatisfactory, the health care professional treating patients under automobile insurance coverage may seek resolution by following the Alternate Dispute Resolution process as outlined in N.J.A.C. 11:3-5.