Claims Assistance Program
MSNJ Claims Assistance Program
The Claims Assistance Program helps MSNJ members with payer issues, including but not limited to: claims payment; termination without notice; and recoupment.
Step 1: Preliminary Form
Members should provide preliminary information through our online form.
This information may also be taken over the phone by the MSNJ Member Resource Center at 609.896.1766 ext. 0.
Step 2: Staff Analysis and Additional Information
MSNJ staff will analyze the submitted form and determine whether additional information is necessary in order to investigate. If documentation is needed, the member will be asked to provide:
Step 3: Referral
MSNJ will write to the appropriate contact on behalf of the member. This will usually include a high level contact at the payer and/or the NJ Department of Banking & Insurance (DOBI). In general, MSNJ first allows payers to respond to inquiries before involving DOBI, unless there is a lack of response from the payer.
Step 4: Follow-up
MSNJ tracks all inquiries to identify trends and review progress. MSNJ staff will follow-up with payers on a monthly basis. Upon receipt of a response from the payer and/or DOBI, MSNJ staff will notify the member. If unsuccessful, MSNJ will provide the member with resources for next steps
MSNJ is often able to facilitate resolution through the Claims Assistance Program; unfortunately, MSNJ cannot always guarantee success. For this reason, we recommend that members continue to pursue these issues on their own, while MSNJ reviews and investigates.
Issues that are older than one year will not be accepted unless follow-up is adequately documented.
This is benefit is available to MSNJ members only.