State IDR · NJ

New Jersey out-of-network disputes

Binding final-offer arbitration.

Summary as of October 12, 2026Not legal adviceSource 12Source 17
Law
Out-of-network Consumer Protection, Transparency, Cost Containment and Accountability Act, P.L. 2018, c. 32 (amended P.L. 2022, c. 74)
Regulator
Department of Banking and Insurance (DOBI), with Maximus Federal as arbitrator
Who it covers

Plans and services in scope

  • Plans issued in New Jersey, and self-funded plans covering New Jersey residents that have opted in.
  • Emergency or urgent care, and inadvertent out-of-network services at in-network facilities.
  • Disputes where the parties’ final offers differ by $1,000 or more.
Timeline
  1. Within 60 days of the carrier’s noticeProvider rejects the initial allowed amount and negotiation starts.
  2. 60 days from the carrier’s noticeNegotiation window closes.
  3. Within 60 days of the final offer due dateEither side may start binding arbitration with Maximus.
How Revise handles it

The engine checks plan situs and opt-in status for every New Jersey claim, runs the 60-day windows and files with Maximus when the $1,000 threshold is met.

Fees

Maximus charges separate application and arbitration fees. Check the current schedule on the Maximus New Jersey portal.

Where federal IDR applies

A self-funded plan that did not opt in on the date of service is excluded and goes to the federal process.

Other states

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Sources

  1. 12Maximus Federal, New Jersey P.L. 2018, c. 32 out-of-network arbitration FAQs: 60 days to dispute the initial allowed amount and negotiate, arbitration within 60 days of the final offer, $1,000 threshold. Source
  2. 17New Jersey Department of Banking and Insurance, out-of-network arbitration report: 28,671 arbitration requests received from 2018 through December 31, 2025. Source