39:6A-5.3 Definitions relative to electronic submission of certain automobile insurance claims.

1. As used in this act:

"Complete electronic medical bill" means a medical bill that meets all of the following criteria: (1) it is submitted in the correct uniform billing format, with the correct uniform billing code sets, transmitted in compliance with the guidelines; (2) the bill and electronic attachments provide all information required under the guidelines established by this act; and (3) the health care provider or its billing representative has provided all information that the insurance carrier or its third party administrator requested.

"Electronic bill" means a communication between computerized data exchange systems that complies with the guidelines enumerated; or a mutually agreed upon electronic data exchange plan established between health care providers or their billing representatives and insurance companies or their third party administrators.

"Guidelines" means the current version of the ASC X12 005010 format.

"Insurance carrier" means any company underwriting personal injury protection coverage benefits payable under a standard automobile insurance policy pursuant to section 4 of P.L.1972, c.70 (C.34:6A-4); a basic automobile insurance policy pursuant to section 4 of P.L.1998, c.21 (C.39:6A-3.1); or emergency care medical expense benefits payable under a special automobile insurance policy pursuant to section 45 of P.L.2003, c.89 (C.39:6A-3.3), and shall include any managed care organization associated with the carrier.

L.2017, c.369, s.1.