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Insurance law Alert

New Jersey Department of Insurance Bulletin No. 20-19, issued on April 24, 2020,  requires that effective immediately and continuing for the duration of the state of emergency and public health emergency declared pursuant to Governor Murphy’s  Executive Order 103, the Department is requiring that automobile insurance carriers implement telemedicine or telehealth procedures with regard to Personal Injury Protection (PIP coverage) under their policies.  Specifically, the Bulletin provides that such carriers:

  • review or establish their telemedicine and telehealth networks to ensure adequacy given the increased demand;
  • encourage network providers to utilize telemedicine or telehealth services wherever possible and clinically appropriate to diagnose and treat PIP injuries during the ongoing public health emergency, in order to minimize exposure of provider staff and other patients to those who may have the COVID-19 virus;
  • update their procedures to include reimbursement for telehealth services that are provided by a provider in any manner that is practicable and appropriate, including by telephone;
  • reimburse providers that deliver covered services to claimants via telemedicine or telehealth in accordance with this guidance; 
  • ensure that the payment to providers for services delivered via telemedicine or telehealth are not lower than would typically be paid for services rendered via traditional (i.e., in person) methods, and carriers must notify providers of any instructions that are necessary to facilitate billing for such telehealth services;
  • may not impose any restriction on the reimbursement for telehealth or telemedicine that requires that the provider who is delivering the services be licensed in a particular state, so long as the provider is in compliance with P.L. 2020, c. 4 and this guidance; and
  • may not impose additional prior authorization requirements on medically-necessary treatment that is delivered via telemedicine or telehealth, instead of via traditional methods, during this public health emergency.

While health insurers likely have developed telehealth networks and readily available procedures in place , automobile insurers may not and likely will have to act quickly to comply with the Bulletin’s mandate.  The Bulletin is linked here


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