Listed below you will find the major key elements of A2123 which is strongly supported by the New Jersey Society of Independent Physical Therapists.
- Reduce the turnaround time for provider authorization requests from 15 days to 3.
- Eliminates mandatory authorization under insurance, but allows provider to seek such authorization.
- Mandate peer review by a NJ licensed PT if services are reviewed.
- Applies the current State-mandated PIP fee schedule for PT services to all payers, with no arbitrary caps.
- Require that reimbursement be based upon this fee schedule, regardless of network participation status.
- Restricts reimbursement for physical therapy services solely to individual physical therapists or properly organized groups of physical therapists.
- Assures ownership & control of physical therapy services by PTs exclusively.
- Prohibits reduction of PT claim amounts by the so-called “Silent-PPOs”.
- Eliminates all “Referral” requirements for PT claims.
- Regulates how reviews of physical therapy care are performed, rather than just requiring peer review.
- Requires independent examination of a patient by another PT, at payer expense, when medical necessity of plan of care is questioned.
- Establishes that Physical Therapists shall be considered “Physicians” for purposes of coverage and benefit determinations, under both self-insured and other insurance plans.
- Ensures that payer must accept patient assignment of claims to provider, regardless of network status.
- Redefines “Covered” under NJ law, to establish minimum payment requirements.
- Eliminates use of proprietary & subjective review criteria by insurers.
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