• posted: Apr. 24, 2013
On behalf of Licatesi Law Group, LLP on Wednesday, April 24, 2013.

There are new amendments to the No-Fault regulations, effective 4/1/13. They apply to all services provided after 4/1/13. In a nutshell, they are:

  1. A provider has 120 days to respond to verification requests asking for documents; NOT EXAMINATIONS. If not submitted within 120 days, then the insurer may deny for failure to supply the verification, regardless of whether the denial is timely or not. If a document is not within the custody or control of the provider, the provider must give written proof within 120 days (e.g. saying that they do not have the document, or it does not exist, etc.).
  2. The amount of the bill that is over the fee schedule is not considered to be received.
    1. Example: If a provider bills $76.03 bill for physical therapy in one day, then the insurer would only be liable for $67.60, regardless of whether the denial is timely or not.
  3. Claims for services or supplies that have not been provided are not considered to be received either. The insurer may deny regardless of whether the denial is timely or not.
  4. Technical defects in an NF-10 are excused.
    1. Example: Obvious typographical errors that would not prejudice either party if determined to be a technical defect.