info@mdrevenuegroup.com9:00 AM - 5:00 PM | Mon - Fri
NJ FamilyCare enrolls its members into one of five managed care organizations: Horizon NJ Health, Aetna Better Health, Fidelis Care, Wellpoint, and UnitedHealthcare Community Plan. Each one sets its own prior-authorization rules and its own appeal process. A claim that clears Horizon NJ Health without a hitch can bounce at Aetna Better Health for a missing authorization the first plan never required. We build a separate workflow for each of the five.
New Jersey's Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act (P.L. 2018, c.32) bars balance-billing patients past their in-network cost-sharing for emergency care and inadvertent out-of-network visits. Disputed claims go through mandatory good-faith negotiation, and if that fails, binding arbitration. A lot of practices treat an out-of-network emergency claim as a write-off. It's a claim with a legal path to full or near-full reimbursement, and that path has deadlines. Miss one and the arbitration option is gone for good.
New Jersey's telehealth payment parity requirement, which forced insurers to reimburse telehealth visits at the same rate as in-person ones, expired on July 1, 2026. Practices that leaned on telehealth for routine follow-ups now have a payer-by-payer question to answer: does this plan still pay parity rates voluntarily, or did it quietly drop to a lower telehealth fee schedule the day the law lapsed? We're already seeing the first answers come back from claims filed this month, and they aren't consistent across payers.
Hackensack Meridian Health and RWJBarnabas Health between them touch a huge share of North and Central Jersey referrals. Atlantic Health System, Virtua Health, Inspira Health, and Cooper University Health Care carry similar weight in their own regions. Credentialing a provider across two or three of these systems, plus Horizon and the five FamilyCare plans, is an ongoing enrollment workload, not a one-time task, and it's bigger than most in-house billing staff were ever sized to handle.
Claims submission, scrubbing, and collections built around the specific quirks of NJ FamilyCare's five-plan structure, not a generic national template stretched to fit New Jersey.
Learn MoreFull-cycle RCM from eligibility verification through payment posting, with workflows tuned to Horizon's market share and the payer mix specific to your county.
Learn MoreProvider enrollment across Horizon BCBSNJ, all five NJ FamilyCare MCOs, and the major hospital-affiliated networks your referrals actually come from.
Learn MoreA free audit that checks specifically for missed out-of-network arbitration eligibility and telehealth parity underpayment, the two leakage points we see most in New Jersey practices right now.
Learn MoreFront-desk and administrative support that scales with a growing New Jersey practice without adding office space or new hires.
Learn MoreBenchmarks your claims data against current NJ payer-specific denial patterns, including the post-parity telehealth shift, to find revenue you are not currently collecting.
Learn MoreLocal visibility support built for a dense, multi-county market where patients are choosing between three or four practices within a 10-minute drive.
Learn More| New Jersey Regulation | The Generic Billing Trap | The MD Revenue Group Approach |
|---|---|---|
| OON Protection Act (P.L. 2018, c.32) | Writing off emergency or inadvertent out-of-network claims, missing the legal pathways to full reimbursement. | We identify eligible claims, negotiate within statutory windows, and handle binding DOBI arbitration. |
| Telehealth Parity Expiration | Billing telehealth services at standard in-person rates across all payers after the July 1, 2026 mandate lapse. | We check and align fee schedules payer by payer to ensure clean submissions and correct modifiers. |
| 5-Plan FamilyCare Medicaid | Treating NJ FamilyCare as one program, leading to auth and coding denials when plans change. | We build custom workflows for Horizon NJ Health, Aetna, Fidelis Care, Wellpoint, and UnitedHealthcare. |
| Horizon BCBS Dominance | Accepting low reimbursement or ignoring complex prior-auth referral networks from the dominant state payer. | We configure dedicated submitter IDs and check local referral registries to secure clean claim approvals. |
We check your last 90 days of claims for telehealth parity underpayment and missed out-of-network arbitration windows under P.L. 2018, c.32.
A written plan targeting the specific leakage points the audit found, not a generic onboarding checklist.
Your existing vendor keeps running while we credential and build claim rules in parallel, proven on real claims first.
Real-time reporting on collections, denials, and A/R velocity, so you see the recovery as it happens, not at quarter-end.
Our local New Jersey billing experts identified a systematic telehealth coding error post-parity expiration and leveraged P.L. 2018, c.32 arbitration to recover uncollectible OON claims.
See What We Can Recover For YouNew Jersey's payment parity mandate forcing insurers to reimburse telehealth visits at in-person rates expired on July 1, 2026. Payer-by-payer fee schedules are diverging, with several commercial plans slashing reimbursement rates by 20% to 40% for telemedicine codes.
The NJ Department of Banking and Insurance (DOBI) has updated its binding arbitration portals for P.L. 2018, c.32 out-of-network claims. Negotiation windows are strictly calculated starting 30 days post-initial payment. Missed deadlines completely waive provider arbitration rights.
HHSC and DOBI have revised prior-authorization requirements for home-care, pediatric, and behavioral health specialty codes across all five FamilyCare MCOs. Horizon NJ Health has updated its portal submission interfaces.
We check specifically for telehealth parity drops, FamilyCare MCO auth shifts, and out-of-network arbitration eligibility.
