NJ DOBI PUBLISHES GUIDANCE FOR PRIOR AUTHORIZATIONS AND MORE

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The NJ Department of Banking and Insurance (NJ DOBI)  posted a bulletin  to advise health care professionals that a new act, Ensuring Transparency in Prior Authorization Act (ETPAA) replaces an  older act known as Health Claims Authorization, Processing and Payment Act (HCAPPA) and takes effect on January 1, 2025.  In addition to regulations related to the prior authorization process, the ETPAA also includes provisions regarding the prompt payment of claims, overdue claims, interest, internal appeal mechanisms and the arbitration process under the Program for Independent Claims Payment Arbitration (PICPA).  .  

Contact the attorneys at Gottuso Law to discuss these new regulations.

The Federal No Surprise Act, effective January 1, 2022, was passed to prohibit surprise billing in certain circumstances.  Since it was passed however, the law has been subject to various lawsuits and as a result, certain portions of the law were vacated or changed.  In December 2023, CMS published a guidance document so that disputing parties could be better educated on the process.  The document can be found at :https://www.cms.gov/files/document/federal-independent-dispute-resolution-guidance-disputing-parties.pdf