Outsourced billing for New Jersey practices at 4-8% of collections, plus credentialing, with no long-term contract. NJ FamilyCare, Medicare and employer plans billed for practices from Newark, Jersey City, Paterson outward.
New Jersey Medicaid runs through NJ FamilyCare managed care, with five plans: Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan and Wellpoint. Commercially, practices bill Horizon Blue Cross Blue Shield of New Jersey, the national carriers and many New York and Pennsylvania plans.
New Jersey passed its own Out-of-Network Consumer Protection Act in 2018 (P.L. 2018, c.32), with disclosure rules and baseball-style arbitration, before the federal No Surprises Act existed. Insurers must pay clean electronic claims within 30 days and paper claims within 40.
NJ FamilyCare claims, plus Medicare and the major private plans in New Jersey
A therapy practice gets coders who know therapy, and the same goes for psychiatry or ABA
One named person to call about your account, not a shared inbox
Fees run 4-8% of collections, without a long-term contract
Billing for the five NJ FamilyCare plans and New Jersey Medicaid
HIPAA compliant from intake to payment posting, with a dedicated account manager for your practice
A free billing assessment is the easiest place to start: call 888-777-0860 or send us a note.
What we handle for New Jersey practices under NJ FamilyCare and the state's out-of-network law:
Behavioral health and therapy are our specialty, and we also handle billing for other New Jersey practices.
Northern New Jersey is home to major medical centers run by Hackensack Meridian Health, RWJBarnabas Health and Atlantic Health System. Patients move between New Jersey and New York for care, so practices bill both states' plans.
Many specialty practices and ambulatory surgery centers in Bergen and Essex counties compete for the same commercial payer contracts.
Specialties: Cardiology, oncology, orthopedics, gastroenterology, dermatology
Central New Jersey's healthcare market includes Robert Wood Johnson University Hospital, Penn Medicine Princeton Health and Capital Health in Trenton. The region draws patients from both the New York and Philadelphia areas, so practices see plans from both.
Rutgers Robert Wood Johnson Medical School brings academic practice billing, and pharmaceutical employers provide employer-sponsored coverage.
Specialties: Primary care, pediatrics, OB/GYN, psychiatry, endocrinology
Southern New Jersey is closely tied to Philadelphia, with Cooper University Health Care and Virtua Health as regional anchors. Many residents carry Philadelphia-based plans such as Independence Blue Cross.
Summer visitors at the Shore and Atlantic City change claim volume through the year.
Specialties: Family medicine, urgent care, orthopedics, behavioral health, cardiology
NJ FamilyCare is New Jersey's Medicaid and CHIP program, run through five plans: Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan and Wellpoint. Each plan has its own authorization rules, network and fee schedule.
It protects patients from surprise bills for inadvertent out-of-network services and sets up baseball-style final-offer arbitration for payment disputes between providers and plans. It is codified at N.J.S.A. 26:2SS-1 to -20, and the federal No Surprises Act also applies.
New Jersey requires insurers to pay or deny clean electronic claims within 30 days and paper claims within 40 days. Late payments carry simple interest of 10% a year.
New Jersey practices often treat patients on New York or Pennsylvania plans. That means enrollment with out-of-state payers and billing each one under its own state's rules.
NJ FamilyCare allows one year from the date of service, but EPSDT and HealthStart claims are due within 30 days. Medicare claims are due within one calendar year of the date of service (42 CFR 424.44). Commercial insurers and Medicaid managed care plans each write their own filing limit into the provider contract, so there is no single number to rely on.
Beyond New Jersey, Medtransic serves practices in neighboring states as well:
Want a second look at your New Jersey practice's billing? Contact Medtransic for a free, no-obligation practice assessment. Call us at 888-777-0860 or submit a contact form, and let us handle the billing so you can focus on your patients.