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Same Specialty Case Review - Pilot Program

MSNJ will assist members by providing recommendations from the Claims Review Program’s panel of board certified, actively practicing physicians for same-specialty reviews of coding and reasonableness of fees.

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 what documentation is necessary for same specialty review. The member will be asked to provide:

  • HIPAA Business Associate Agreement for MSNJ to sign as the practice’s business associate; MSNJ will provide the member with a sample, if needed; and
  • Fully redacted documentation. MSNJ will: provide instructions on proper redaction and send a secure email that the member may use to respond. Alternatively the member may fax redacted documentation to MSNJ’s secure fax at: 609.896.1884 or mail via certified mail to: Medical Society of New Jersey, Attn: Claims Review Program, 2 Princess Road, Lawrenceville, NJ 08648.

Step 3: Referral

MSNJ staff will send the redacted file to a same specialty reviewer for analysis. MSNJ staff will make all attempts to resolve reviewer conflicts and reviewers are obligated to notify MSNJ immediately of potential conflicts.

Step 4: Follow-up

MSNJ will issue each case a tracking number and track all inquiries to ensure timely reviewer response. MSNJ staff will provide the member with a copy of the reviewer’s findings, upon receipt from the reviewer.

This is benefit is available to MSNJ members only.