No. A participating dentist is required to honor the contracted fee schedule for covered services provided to patients enrolled in plans that are subject to the dentist's participation agreement. 

Under N.J.S.A. 26:2S-26 and 26:2S-27, a carrier cannot require a participating dentist to accept a carrier-established or carrier-approved fee for a service unless it is a covered service under the patient's dental plan. 

Your obligations are governed by your participation agreement, including any amendments or leased-network provisions. Before billing a patient, review your provider agreement to determine whether the plan is included in your contract and whether any contractual limitations apply.

A contractual write-off applies when a participating dentist provides a covered service to a patient enrolled in a plan subject to the dentist's participation agreement. In those circumstances, the dentist agrees to accept the contracted fee as payment in full, less any applicable patient responsibility, such as deductibles, copayments, or coinsurance. 

Under N.J.S.A. 26:2S-26, a service remains a covered service even if the carrier pays nothing because of a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative-benefit provision, or another contractual limitation under the patient's dental plan. In these situations, the contracted fee continues to apply. 

If a service is excluded from coverage and is not a covered service under the patient's plan, the contracted fee generally does not apply, subject to the provider agreement and applicable law.

It depends on why the service is not being paid. 

Under N.J.S.A. 26:2S-26 and 26:2S-27, a carrier cannot require a participating dentist to accept a carrier-established or carrier-approved fee for a service that is not a covered service under the patient's dental plan. 

However, a service is not considered non-covered simply because the carrier pays nothing. Under N.J.S.A. 26:2S-26, services remain covered when reimbursement is unavailable because of a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative-benefit provision, or another contractual limitation under the patient's dental plan. In those situations, the contracted fee generally continues to apply. 

If the procedure is excluded from the patient's plan and is not a covered service, New Jersey law does not prohibit the participating dentist from charging the practice's regular office fee. Dentists should also review their participation agreement to determine whether any contractual provisions, leased-network arrangements, or plan-specific requirements apply. 

These statutory protections do not necessarily apply to self-funded employer-sponsored plans governed by the Employee Retirement Income Security Act (ERISA), which may be subject to different legal requirements.

Not necessarily. A claim denial does not automatically mean the patient is responsible for the full charge. 

Whether a patient may be billed depends on why the claim was denied, whether the service is considered a covered service under N.J.S.A. 26:2S-26, the terms of the patient's dental plan, and the dentist's participation agreement. 

For example: 

• If the procedure is excluded from the patient's plan and is not a covered service, New Jersey law does not prohibit a participating dentist from charging the practice's regular office fee, subject to the provider agreement and applicable law.  

• If the claim is unpaid because of a deductible, copayment, coinsurance, waiting period, annual or lifetime maximum, frequency limitation, alternative-benefit provision, or another contractual limitation, the service remains a covered service and the contracted fee generally continues to apply.  

• If the claim is denied because the participating dentist failed to comply with contractual requirements, such as prior authorization, timely filing, or documentation requirements, the provider agreement may prohibit billing the patient.  

When applicable, N.J.S.A. 26:2S-33.1 establishes additional requirements before a participating dentist may collect payment directly from a patient for a covered procedure or service. 

Always review the Explanation of Benefits (EOB), the patient's dental plan, and your participation agreement before billing the patient.

Many dental benefit carriers access provider networks through leased-network arrangements. If your participation agreement authorizes network leasing, you may be contractually obligated to accept negotiated fees for patients whose benefits are administered through those arrangements. 

Before disputing reimbursement or billing the patient, determine whether the carrier accessed your participation agreement through a leased network and review the applicable contract terms. The existence of a leased network does not change the statutory distinction between covered services and non-covered services under N.J.S.A. 26:2S-26 and 26:2S-27, but it may determine whether a particular plan is subject to your participation agreement. 

Network leasing occurs when a dental insurance company or PPO leases its participating provider network to another insurance carrier, third-party administrator (TPA), or employer-sponsored dental plan. As a result, a dentist may receive reimbursement at a contracted PPO rate from a payer with whom the dentist does not have a direct contract. 

Whether network leasing is permitted depends on the terms of your participating provider agreement. Many agreements expressly authorize the carrier to lease its network to other entities, while others place limitations on this practice. 

For additional information about network leasing, network vendors, and network administrators, see the NJDA article: Understanding Network Leasing, Network Vendors, and Network Administrators in New Jersey 

Review your participating provider agreement to determine whether you authorized the carrier to lease your network participation to third parties. If your agreement permits network leasing, you may be contractually obligated to accept the negotiated fee schedule for plans accessing your contract through an authorized leased network. 

If you are uncertain why a claim was processed at a discounted rate, request that the payer identify: 

• The network used to process the claim; 

• The specific provider agreement under which the discount was applied; and 

• The contractual authority permitting the network lease. 

Maintaining copies of your provider agreements and any amendments can help verify whether the discount was applied appropriately.

Not necessarily. A payer may only apply a discounted fee schedule if it has contractual authority to do so, such as through a valid network leasing provision contained in your participating provider agreement. If you do not have a direct contract with the payer, request documentation identifying the agreement or leased network that authorizes the discounted reimbursement. 

If the payer cannot identify a contractual basis for applying the discount, you may wish to request a claim review or reimbursement reconsideration.

Yes. New Jersey law regulates third-party access to dental provider network contracts. Under N.J.S.A. 17B:30-60 through 17B:30-63, a dental carrier must clearly disclose in the provider network contract whether third parties are permitted to access the network. The provider contract must include a provision allowing the provider to choose whether to participate in third-party access when the contract is entered into and each time the contract is renewed. 

In addition, N.J.S.A. 17B:30-61 requires a dental carrier to maintain a publicly available list of third parties that have access to its provider network contracts. N.J.A.C. 11:24C-4.3 requires that a provider agreement specifically authorize third-party access before a carrier makes the agreement available to a third party, and that the third party comply with the terms of the provider agreement. 

For self-funded employer-sponsored plans, however, the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a), may preempt certain state insurance laws. While the provider agreement remains enforceable according to its terms, disputes involving self-funded plans may be governed by federal law rather than New Jersey insurance statutes.

Under N.J.S.A. 17B:30-61, a dental carrier must allow a provider to choose whether to participate in third-party access to the provider network contract when the contract is entered into and each time the contract is renewed. The third-party access provision must be clearly identified in the provider agreement. 

Providers should review their provider participation agreement for the applicable third-party access provisions and follow the carrier’s process for declining participation. The opt-out process is determined by the terms of the provider agreement and the procedures established by the carrier. 

If you believe a payer improperly applied a discounted PPO fee, you should: 

• Request an explanation of how the claim was priced. 

• Ask the payer to identify the network and provider agreement authorizing the discount. 

• Compare the reimbursement to your current participation agreement and fee schedule. 

• Submit a written reconsideration request if you believe the discount was applied in error. 

• If the issue involves a fully insured plan regulated by New Jersey law and cannot be resolved with the payer, you may also consider filing a complaint with the New Jersey Department of Banking and Insurance (DOBI). For self-funded ERISA plans, disputes generally must be resolved through the plan's contractual appeal process.

A retroactive denial, commonly referred to as a clawback, occurs when a dental benefit payer seeks to recover payment for a claim that was previously paid. A payer may request repayment months—or in some cases years—after payment, citing reasons such as: 

• Changes in patient eligibility; 

• Coordination of benefits (COB) corrections; 

• Duplicate payments; 

• Claim processing errors; or 

• Other alleged overpayments. 

Before issuing a refund, review the payer's explanation, the patient's benefit information, and your participating provider agreement to determine whether the repayment request is supported.

Yes. Many payer contracts allow the recovery of legitimate overpayments. However, the payer should identify the basis for the alleged overpayment and provide documentation supporting its request. 

If you receive a repayment demand, request: 

• The reason for the overpayment; 

• The affected claim(s); 

• The contractual or plan provision supporting the recovery; and 

• A detailed calculation of the amount requested. 

Do not assume that a repayment request is correct simply because the claim was previously paid.

It depends on the type of dental plan. 

For fully insured dental plans regulated by New Jersey law, N.J.S.A. 17B:30-53 generally prohibits a carrier from seeking recovery of an overpayment more than 18 months after the date the first payment was made, except in limited circumstances, such as fraud, financial insolvency, or when recovery is required because another payer is primary under coordination of benefits rules. 

For self-funded employer-sponsored plans, the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a), generally preempts state insurance laws. As a result, the overpayment recovery provisions in N.J.S.A. 17B:30-53 generally do not apply, and the payer's recovery rights are governed by the applicable ERISA plan documents and provider agreement.

If you believe the repayment request is incorrect, review the Explanation of Benefits (EOB), patient eligibility, coordination of benefits information, and your participating provider agreement. If appropriate, submit a written appeal or request reconsideration according to the payer's appeal procedures. Include any documentation supporting the original claim, such as clinical records, narratives, or coordination of benefits information. 

Maintaining complete documentation can help support your position if the repayment request is disputed. 

Yes. If a payer later determines that another dental or medical plan was primary, the patient was not eligible on the date of service, or the claim was otherwise paid incorrectly, it may seek to recover the overpayment, subject to applicable law and the terms of the provider agreement. 

Before issuing a refund, verify that the payer has correctly applied the patient's eligibility and coordination of benefits information and request supporting documentation if necessary. 

Coordination of Benefits (COB) is the process used to determine the order in which multiple dental or medical benefit plans pay when a patient is covered under more than one plan. COB is intended to prevent duplicate payments while ensuring that benefits are paid in accordance with the terms of each plan. 

For fully insured dental plans issued in New Jersey, carriers must coordinate benefits in accordance with N.J.A.C. 11:4-28 (Coordination of Benefits). Self-funded employer-sponsored plans governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a), may follow different COB provisions established in the plan documents.

The order of benefit determination depends on the coordination of benefits (COB) provisions contained in the patient’s dental benefit plans. The plan identified as primary pays benefits first, and the plan identified as secondary considers the benefits available under the primary plan when determining its payment responsibility. 

For fully insured plans subject to New Jersey insurance requirements, N.J.A.C. 11:4-28 establishes the rules used to determine the order of benefits. The regulation includes several methods for determining primary and secondary coverage based on the circumstances of the patient’s coverage. 

For dependent children covered under both parents’ plans, the “birthday rule” applies when the parents are not separated or divorced. Under this rule, the plan of the parent whose birthday occurs earlier in the calendar year is considered the primary plan. Only the month and day of the parent’s birthday are used; the year of birth is not considered. If both parents have the same birthday, the plan that has covered the parent longer is considered primary. 

Other COB rules under N.J.A.C. 11:4-28 address situations such as: 

• Employee or subscriber coverage versus dependent coverage: A plan that covers an individual as an employee, member, or subscriber is considered before a plan that covers the individual as a dependent.  

• Dependent children of separated or divorced parents: The regulation provides specific rules for determining the order of benefits, including consideration of custody arrangements and court orders assigning responsibility for the child’s healthcare expenses.  

• Other coverage situations: The regulation provides additional methods for determining the order of benefits when the standard rules do not determine which plan pays first.  

For self-funded employer-sponsored plans, the plan documents govern the order of benefits. Because self-funded ERISA plans are governed by federal law, their COB provisions may differ from New Jersey insurance COB requirements. Providers should review the applicable plan provisions to determine which plan is primary and which plan is secondary.

Secondary coverage does not necessarily pay the entire remaining balance after the primary plan processes a claim. Many dental plans include limitations on secondary payments, such as maximum annual benefits, frequency limitations, or non-duplication of benefits (maintenance of benefits) provisions. 

Under a non-duplication provision, the secondary plan may reduce or eliminate its payment if the primary plan has already paid an amount equal to or greater than what the secondary plan would have paid as the primary insurer. As a result, the patient may still have out-of-pocket responsibility even after both plans have processed the claim. 

A non-duplication (also called maintenance of benefits) provision allows a secondary plan to reduce its payment by taking into account the amount already paid by the primary plan. Rather than paying the difference between the primary payment and the provider's fee, the secondary plan calculates what it would have paid as the primary payer and may pay only the difference—or nothing at all. 

These provisions are common in employer-sponsored dental plans and are generally permitted if they are clearly described in the patient's benefit plan.

Your reimbursement is generally determined by your participation status with the payer that is processing the claim and the terms of your provider agreement. 

If you are participating with the primary payer, the claim is generally reimbursed according to your contracted fee schedule with that carrier. If the secondary payer also has a contractual relationship with you—either directly or through a leased network—it may apply its own contracted fee schedule when processing the secondary claim. 

Because network participation and reimbursement obligations vary by contract, review your participating provider agreements and verify whether either payer is accessing your contract through a leased PPO network.

If you believe a claim was processed incorrectly due to Coordination of Benefits, first verify the patient's current insurance information and confirm which plan should be primary. If necessary, request that the payer explain the basis for its COB determination and provide the applicable plan provisions. 

If you believe the payer has incorrectly applied the COB rules or processed the claim using inaccurate eligibility information, submit a request for reconsideration or appeal in accordance with the payer's policies and include any supporting documentation, such as updated eligibility information or Explanation of Benefits (EOB) statements from the other carrier. 

Begin by reviewing the Explanation of Benefits (EOB) to determine the reason for the denial or reduced payment. Common reasons include missing documentation, eligibility issues, frequency limitations, lack of preauthorization, coordination of benefits (COB), or a determination that the service was not covered or not dentally necessary. 

If you believe the claim was processed incorrectly, contact the payer for clarification and, if appropriate, submit an appeal or request for reconsideration in accordance with the payer's policies.

The documentation needed will depend on the reason for the denial, but may include: 

• Clinical narratives explaining the treatment provided; 

• Diagnostic radiographs or photographs; 

• Periodontal charting or other clinical findings; 

• Patient records supporting the diagnosis; 

• Copies of the original claim and Explanation of Benefits (EOB); and 

• Any additional documentation requested by the payer. 

Providers should review the applicable plan provisions and denial explanation to determine what documentation is required for the specific appeal. Submitting complete supporting documentation with the initial appeal may help avoid delays in the review process. 

Yes. Appeal deadlines are established by the patient's benefit plan or the payer's policies and vary among carriers. Before submitting an appeal, review the EOB, provider manual, or provider agreement to determine the applicable filing deadline. 

For fully insured dental plans issued in New Jersey, insurers must acknowledge, investigate, and respond to provider communications regarding disputed claims in accordance with N.J.A.C. 11:24A-3.5. Prompt payment requirements for clean claims are established under N.J.A.C. 11:22-1.5, although those provisions do not establish a uniform appeal deadline. 

A clean claim is a claim that can be processed without the need for additional information, investigation, or clarification from the provider or another party. Under N.J.A.C. 11:22-1.2, a clean claim means a claim that has no material defect or impropriety, including any lack of required substantiating documentation, that prevents timely payment. 

A claim is not considered clean if it requires additional information to determine payment responsibility, such as missing documentation, incorrect or incomplete information, or other issues that prevent the payer from processing the claim. 

For fully insured plans subject to New Jersey prompt payment requirements, N.J.A.C. 11:22-1.5 establishes timeframes for the payment of clean claims. Providers should ensure that claims are complete and include all required information and supporting documentation to facilitate timely processing. 

Yes. If you believe the denial was incorrect, you may submit an appeal with additional clinical documentation supporting the necessity of the treatment. This may include detailed narratives, diagnostic radiographs, periodontal charting, photographs, or other records demonstrating why the procedure was appropriate for the patient's condition. 

When appealing a medical or dental necessity determination, address the specific reason for the denial and explain how the clinical findings support the treatment rendered.

Yes. For self-funded employer-sponsored plans, appeal rights are governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1001 et seq. ERISA requires employee benefit plans to establish a reasonable claims procedure and provide a full and fair review of denied claims pursuant to 29 U.S.C. § 1133 and 29 C.F.R. § 2560.503-1. 

Because appeal procedures, deadlines, and documentation requirements are established by the plan documents, providers should carefully review the patient's benefit plan and follow the instructions provided by the plan administrator. 

If the payer upholds its denial, review the explanation carefully to determine whether additional appeal rights are available. Some payers offer multiple levels of internal review, while self-funded ERISA plans may provide additional appeal procedures outlined in the plan documents. 

If the dispute involves a fully insured dental plan regulated by New Jersey law and cannot be resolved directly with the carrier, you may also consider filing a complaint with the New Jersey Department of Banking and Insurance (DOBI). For self-funded ERISA plans, disputes are generally resolved through the plan's appeal process because ERISA, 29 U.S.C. § 1144(a), generally preempts state insurance laws.

Credentialing is the process by which a dental benefit payer verifies a dentist's qualifications before allowing the dentist to participate in its provider network. This process typically includes verification of licensure, education, malpractice history, National Provider Identifier (NPI), and other professional credentials. 

Dentists should complete the credentialing process and receive confirmation of network participation before providing services as an in-network provider, unless otherwise permitted by the payer. 

Although the terms are often used interchangeably, they serve different purposes. 

• Credentialing is the review and verification of a dentist's professional qualifications to determine eligibility for network participation. 

• Provider enrollment is the administrative process of establishing the provider in the payer's claims system so claims can be submitted and payments can be issued under the appropriate provider and practice information. 

Many payers require both processes to be completed before claims will be processed as in-network.

Dentists should promptly notify participating payers whenever there is a material change to their practice, including: 

• A change in practice ownership; 

• A new Tax Identification Number (TIN); 

• A change in practice location or mailing address; 

• A change in National Provider Identifier (NPI), where applicable; or 

• Changes to licensure or other credentialing information. 

Failure to timely report these changes may delay claims processing, reimbursement, or network participation. 

Most dental benefit payers require participating providers to complete recredentialing periodically, often every three years, although the frequency varies by carrier. Recredentialing allows the payer to verify that the provider continues to meet its participation requirements, including maintaining an active license, professional liability coverage (if required), and other applicable qualifications. 

Dentists should respond promptly to recredentialing requests to help avoid interruptions in network participation. 

If your application is delayed, contact the payer to determine whether additional information or documentation is needed. Keep records of all correspondence and confirmation of submitted materials. 

If your application is denied, request the reason for the denial and determine whether the payer offers an appeal or reconsideration process. Because credentialing requirements vary among carriers, providers should review the payer's policies and provider agreement before submitting additional documentation or requesting further review. 

A complete dental claim should include the information required by the applicable payer and plan requirements. The ADA Dental Claim Form provides a standardized format for submitting dental claims and includes fields for information such as patient and subscriber information, treating dentist information, procedure details, dates of service, tooth numbers or areas of the oral cavity, and other information necessary for claim processing. Providers should follow the current ADA Dental Claim Form instructions when completing and submitting claims. 

The documentation required to support a claim may vary depending on the payer, plan provisions, and the procedure being billed. Provider agreements, plan documents, or payer policies may identify specific documentation requirements for certain procedures or services. Required supporting documentation may include, when applicable: 

• Diagnostic radiographs or photographs;  

• Clinical narratives;  

• Periodontal charting;  

• Treatment records; and  

• Other documentation requested by the payer.  

Submitting a complete and accurate claim with all required information and supporting documentation can help reduce processing delays and requests for additional information. 

For additional information regarding the ADA Dental Claim Form and completion instructions, see: ADA Dental Claim Form

A timely filing deadline is the period within which a claim must be submitted to the payer in order to be considered for payment. Timely filing requirements vary by dental benefit plan and are established by the payer's provider agreement or the patient's benefit plan. 

Providers should review the applicable provider manual or participation agreement to determine the filing deadline, as failure to submit a claim within the required timeframe may result in a denial. 

Yes. If a claim is denied because of missing information, coding errors, or other correctable issues, you may generally submit a corrected claim or request reconsideration, depending on the payer's policies. Be sure to follow the payer's instructions for corrected claims and include any additional documentation needed to support the claim. 

If the denial was based on a coverage determination rather than a clerical error, an appeal may be more appropriate than submitting a corrected claim. 

First, verify the payer's timely filing requirement and confirm the date the original claim was submitted. If you submitted the claim within the required deadline, provide proof of timely submission, such as electronic claim acceptance reports, certified mail receipts, or other submission confirmations, and request that the payer reconsider the denial. 

If the claim was submitted after the filing deadline, review the payer's policies to determine whether any exceptions apply, such as delays caused by coordination of benefits, retroactive eligibility determinations, or other circumstances recognized by the payer. 

For fully insured dental plans regulated by New Jersey law, carriers are generally required to pay, deny, or request additional information for clean claims within the timeframes established by N.J.A.C. 11:22-1.5. Claims that require additional information may take longer to process until the requested documentation is received. 

These prompt payment requirements generally do not apply to self-funded employer-sponsored plans governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a), where claim processing is governed by the terms of the plan.

A pre-payment review occurs when a dental benefit payer delays processing a claim in order to review additional information before issuing payment. During this process, the payer may request clinical records, radiographs, photographs, periodontal charting, narratives, or other documentation to determine whether the submitted procedure meets the plan's coverage requirements. 

For fully insured dental plans regulated by New Jersey law, requests for additional information and claim processing are subject to the requirements of N.J.A.C. 11:22-1.5, which governs the processing of clean claims. 

Downcoding occurs when a payer reimburses a submitted procedure code as a different procedure that it determines is more appropriate based on the patient's clinical documentation or the terms of the benefit plan. As a result, reimbursement may be lower than the amount associated with the code originally submitted by the provider. 

If you believe a claim was downcoded incorrectly, review the Explanation of Benefits (EOB) and request an explanation of the payer's coding determination. 

Depending on the procedure and the reason for the review, a payer may request: 

• Clinical narratives; 

• Diagnostic radiographs; 

• Intraoral or extraoral photographs; 

• Periodontal charting; 

• Study models or scans, where applicable; and 

• Patient records supporting the diagnosis and treatment. 

Providing complete documentation with the initial claim, when appropriate, may help reduce payment delays.

Review the payer's request carefully and submit the requested documentation as soon as possible. If the claim has been downcoded, compare the payer's determination with the clinical documentation and the CDT code that was originally submitted. 

If you believe the payer incorrectly downcoded the procedure or misinterpreted the clinical documentation, submit a written appeal or request for reconsideration explaining why the submitted procedure code accurately reflects the treatment provided. Include any additional supporting documentation that addresses the payer's concerns.

For fully insured dental plans regulated by New Jersey law, N.J.A.C. 11:22-1.5 permits a carrier to request additional information needed to process a claim. Once the requested information is received, the carrier must continue processing the claim in accordance with the applicable prompt payment requirements. 

For self-funded employer-sponsored plans, claim review and payment timeframes are governed by the terms of the ERISA plan rather than New Jersey's prompt payment regulations. 

Yes. If you believe a payer improperly downcoded a procedure or reduced reimbursement, you may submit an appeal or request reconsideration in accordance with the payer's appeal process. Your appeal should include clinical documentation supporting the procedure performed, such as narratives, radiographs, photographs, periodontal charting, or other records demonstrating why the submitted CDT code accurately reflects the treatment provided. 

When possible, address the specific reason provided by the payer for the downcoding or payment reduction to help facilitate review.

A virtual credit card (VCC) payment is an electronic payment method in which a payer issues a one-time-use credit card number to the dental practice instead of sending payment through a paper check or electronic funds transfer (EFT). Practices process the virtual card payment through their credit card terminal or payment processor, similar to a traditional credit card transaction. 

While VCC payments may provide faster access to funds, practices should be aware that they may be subject to credit card processing fees and additional administrative steps. 

No. Under N.J.S.A. 17B:30-34.1, health benefit plans and carriers issuing new or renewed contracts must provide participating providers with the option to select from available payment methods, including electronic funds transfer (EFT), electronic remittance advice (ERA), or paper checks, rather than requiring a provider to accept virtual credit card payments as the only payment option. 

Dental practices should review payer communications and provider agreements to ensure they understand available payment options and how to update payment preferences. 

If your practice prefers another payment method, contact the payer or payment vendor to request an alternative payment method, such as EFT or paper check, when available. 

Keep records of any communications regarding payment preferences and confirm that your requested payment method has been updated to avoid continued issuance of unwanted VCC payments. 

Yes. Unlike EFT payments, which typically do not involve credit card processing fees, virtual credit card payments may result in merchant processing fees deducted from the payment amount received by the practice. 

Before accepting VCC payments, practices should evaluate whether the administrative convenience outweighs any associated fees and determine whether another available payment method better meets the practice's needs.

If your practice is enrolled in VCC payments without selecting that payment method, contact the payer or payment processor to request information about available alternatives. Under N.J.S.A. 17B:30-34.1, applicable health benefit plans and carriers must offer participating providers payment method options rather than requiring a single payment method. 

Practices should document requests to change payment methods and retain confirmation of any updates. 

It depends. New Jersey payment method requirements generally apply to fully insured health benefit plans regulated under state law. However, self-funded employer-sponsored plans governed by the Employee Retirement Income Security Act (ERISA), 29 U.S.C. § 1144(a), may not be subject to the same state insurance requirements because ERISA generally preempts state laws that relate to employee benefit plans. 

For self-funded plans, payment practices are generally governed by the terms of the plan, applicable provider agreements, and the arrangement between the employer and plan administrator.