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Prompt Pay Guidelines

All New Jersey insurance companies, health, hospital, medical and dental services corporations, HMOs and dental provider organizations (DPOs) and their agents for payment (all known as payers) must process claims in a timely manner, as required by New Jersey Prompt Pay Law (N.J.A.C. 11:22-1.5).

A carrier or its agent shall remit payment of clean claims pursuant to the following time frames:

  • 30 calendar days after receipt of the claim where the claim is submitted by electronic means or the time established for the Federal Medicare program1 whichever is earlier
  • 40 calendar days after receipt of the claim where the claim is submitted by other than electronic means.

Claims that are not paid must be denied or disputed within the same 30- or 40-day timeframes.

Claims that are not paid, or denied within these timeframes will begin to accrue interest (beginning on the 31st day for electronic claims, and the 41st day for paper claims) as follows:

  • 10% interest rate for dental service corporations and DPO’s
  • 12% interest rate for insurance companies, health, hospital and medical service corporations.

Prompt Pay requirements do not apply to certain lines of business, for example, self-funded businesses we work with as Administrative Services Only (ASO) accounts. If you have questions about identifying members to whom Prompt Pay applies, please call 1-800-624-1110.

¹Per CMS guidelines, a Medicare health plan must pay clean claims from noncontract providers within 30 calendar days of the request and must pay or deny all other claims within 60 calendar days of the request