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PIP Information for Health Care Providers
Find information regarding...
  Automobile Medical Fee Schedule
  Uniform Attending Provider Treatment Plan Form
  Uniform Internal Appeal Forms
  N.J.A.C. 11:3-4 Medical Protocols Rule
(Care Paths, Decision Point Review, Precertification)
  21-Day Notice Rule
  PIP Alternate Dispute Resolution
  Prompt Payment Regulation Information
  Reference/Superceded Materials
 
Automobile Medical Fee Schedule

Auto Medical Fee Schedule Rule and Exhibits - Effective for treatment rendered on or after January 4, 2013
Fee Schedule Rule Text - PDF or MS Word (Effective for treatment rendered on or after January 4, 2013)
Exhibit 1 Physicians' and ASC Fee Schedule - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 2 Dental Fee Schedule - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 3 Home Care Services - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 4 Ambulance Services - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 5 Durable Medical Equipment - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 6 CPT Codes Subject to Daily Maximum - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)
Exhibit 7 Hospital Outpatient Surgical Facility (HOSF) Fee Schedule - PDF or MS Excel (Effective for treatment rendered on or after January 4, 2013)

Automobile Medical Fee Schedule Frequently Asked Questions (for rule effective January 4, 2013)
Appellate Division Case: NJ Healthcare Coalition v NJ DOBI (March 2015)
Automobile Insurance
Readoption with Amendments: N.J.A.C. 11:3
Adopted Repeal and New Rule: N.J.A.C. 11:3-16 Appendix, Exhibit A
Adopted Repeals: N.J.A.C. 11:3-45 Appendix and 11:3-46 Appendix, Exhibit C
Order A12-118: In the Matter of the Request of the New Jersey Association for Justice for a Stay of the Adoption of Amendments and New Rules, N.J.A.C. 11:3-4.2, Et Seq.
Order A12-117: In the Matter of the Request of the United Acupuncture Society of New Jersey for a Stay of the Adoption of Amendments to N.J.A.C. 11:3-29 Appendix, Exhibit 6
Order A12-116: In the Matter of the Request of the New Jersey Coalition for Quality Healthcare for a Stay of the Adoption of Amendments and New Rules, N.J.A.C. 11:3-4.2, Et Seq.
Order A12-114: In the Matter of the Request for a Stay of the Adoption of Amendments and New Rules, N.J.A.C. 11:3-4.2, et seq.
Notice of Adoption that appeared in 11/05/12 New Jersey Register
Document showing all changes to text of rules from Proposal, Notice of Substantial Change and Adoption
Proposed Substantial Changes to Medical Fee Schedule Rule - Comment period ended
Proposed Amendments to Medical Fee Schedule Rule (August 2011) - Comment period ended
 
Uniform Attending Provider Treatment Plan Form
All providers treating PIP patients must use the Uniform Attending Provider Plan Form to submit Decision Point and Precertification Requests to Insurers.
Uniform Attending Provider Treatment Plan Form - PDF or MS Excel
List of Auto Insurers and web sites
Frequently Asked Questions: Uniform Attending Provider Treatment Plan Form
Order A16-101: In the Matter of Changes to the Uniform Attending Provider Plan Form and Decision Point Review and Precertification in Personal Injury Protection
 
Uniform Internal Appeal Forms
Effective April 17, 2017, all providers treating PIP patients must use the Uniform Pre-Service and Post-Service Appeal Forms to submit Internal Appeals to Insurers. (The appeal forms are available in MS-Excel for the convenience of persons who may wish to create online forms. Users are not permitted to change the forms to add codes or other items. Appeal forms that have been altered will be rejected by insurers.)
Pre-Service Appeal Form - PDF or MS Excel
Post-Service Appeal Form - PDF or MS Excel
Frequently Asked Questions: Implementation of Internal Appeal Rule Changes UPDATED (June 7, 2017)
Order A17-103: In the Matter of the Establishment of Uniform Pre-Service and Post-Service Internal Appeal Forms
 
N.J.A.C. 11:3-4 Medical Protocols Rule (Care Paths, Decision Point Review, Precertification)
Full Text of Medical Protocols Rule
(Effective October 17, 2016, except as noted in the rule text)
 
Full text of Medical Protocols Rule Appendix
Registered PIP Vendors
Adopted Amendments to Medical Protocols Rule (October 17, 2016; Operative April 17, 2017)
Frequently Asked Questions: Medical Protocols Rule UPDATED (May 23, 2016)
Notice of Extension of Operative Date regarding Amendments to Medical Protocols Rule (November 2, 2015)
Proposed Amendments to Medical Protocols Rule (November 2, 2015)
Adopted Amendments to Medical Protocols Rule (November 5, 2012)
Proposed Substantial Changes upon Adoption to Medical Protocols Rule - Comment period ended
Bulletin 12-03: Withdrawal of Bulletin No. 10-22
Proposed Amendments to Medical Protocols Rule (August 2011) - Comment period ended
Adopted Amendments to Medical Protocols Rule (July 2010)
 
21-Day Notice Rule
Text of 21-Day Notice Rule
List of Insurer Addresses to Send the Form
 
PIP Alternate Dispute Resolution

Full Text of
Alternate Dispute Resolution Rule
(Effective January 4, 2013)

Administrator Quarterly Reports
  2017 2016
  1st Quarter 1st Quarter
  2nd Quarter 2nd Quarter
  3rd Quarter 3rd Quarter
    4th Quarter
     
  2015 2014
  1st Quarter 1st Quarter
  2nd Quarter 2nd Quarter
  3rd Quarter 3rd Quarter
  4th Quarter 4th Quarter
more

 

Full Text of Alternate Dispute Resolution Rule (Effective July 2010)
Notice of Extension of Operative Date regarding Alternate Dispute Resolution Rule (November 4, 2013)
Notice of Administrative Correction 11:3-5.6 (February 4, 2013)
Adopted Amendments to PIP Alternate Dispute Resolution Rule (November 5, 2012)
Proposed Substantial Changes to Alternate Dispute Resolution Rule - Comment period ended
Proposed Amendments to PIP Alternate Dispute Resolution Rule (August 2011) - Comment period ended
Bulletin 10-30: Interpretation of DOBI Rules on PIP Reimbursements
Adopted Amendments to PIP Alternate Dispute Resolution Rule (June 2009)
Notice to the Bar Concerning the Participation of Insurance Company Employees in PIP Arbitrations (March 18, 2009)

PIP ADR Administrator: Forthright

Certified Medical Review Organizations (Select Company Type: Medical Review Organization)
 
Prompt Payment Regulation Information
Prompt Pay Statute (N.J.S.A. 39:6A-5g)
 
Reference/Superceded Materials
More information
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