Medical Billing in New Jersey
Soft Home Global provides billing, AR follow-up and denial appeals for New Jersey practices and billing companies at $1,850 per seat per month. Full time, worked during New Jersey business hours, inside your own system.
What is specific to New Jersey
NJ FamilyCare runs through managed care organizations with their own enrollment queues.
New Jersey’s Medicaid programme is NJ FamilyCare. Practices with a meaningful NJ FamilyCare mix usually need it worked as its own queue rather than mixed into commercial follow-up, because the submission path, the timely filing window and the appeal route are all different.
What a medical billing seat does in New Jersey
Aged accounts receivable called until they close, and denials read, appealed and tracked.
In New Jersey the queue that costs the most is NJ FamilyCare: 1 year from the date of service (non-institutional); 1 year from discharge (inpatient), and a claim past that date is unpayable rather than late.
- Worklist worked from the difficult end, not the easy end
- Every call logged with the payer reference and the outcome
- Denials categorised so the same reason stops recurring
- Appeals written and submitted, not just re-bills
- Weekly written summary of what moved and what did not
- Worked during New Jersey business hours, not queued overnight
Most of the New Jersey work we see comes out of Newark, Jersey City and Paterson, though nothing about a seat depends on where your office is — the queue is worked through your system, not from your building.
New Jersey borders 3 states, and practices near those lines almost always carry at least one out-of-state Medicaid enrollment. That is a separate portal, a separate filing window and a separate appeal route from NJ FamilyCare, and it is the queue that most often goes unworked because it belongs to nobody.
What New Jersey law gives you
30 calendar days for electronic clean claims; 40 calendar days for paper (non-electronic) clean claims. Interest accrues from day 31 / day 41.
NJ FamilyCare, in practice
NJ FamilyCare moved off fee-for-service starting in 1995 and is now delivered through managed care: five MCOs participate statewide — Aetna Better Health of New Jersey, Fidelis Care, Horizon NJ Health, UnitedHealthcare Community Plan, and Wellpoint (formerly Amerigroup New Jersey). Source
Auto-accident care is a separate, state-controlled billing track: New Jersey is a no-fault PIP state, and under the N.J.A.C. 11:3-4 Medical Protocols Rule every provider treating a PIP patient must file Decision Point Review and precertification requests on the state's Uniform Attending Provider Plan Form, and bill against New Jersey's Automobile Medical Fee Schedule rather than any health-plan fee schedule. DOBI states: 'All providers treating PIP patients must use the Uniform Attending Provider Plan Form to submit Decision Point and Precertification Requests to Insurers.' Source
On the commercial side the dominant Blue plan here trades as Horizon Blue Cross Blue Shield of New Jersey, which matters mainly because its portal and its appeal route are the ones your seat will spend the most time in. Source
How long you have to file a NJ FamilyCare claim
1 year from the date of service (non-institutional); 1 year from discharge (inpatient). A denied claim: within one year of the date of service or 30 days of adjudication, whichever is later.
“One year of the date of service” N.J.A.C. 10:49-7.2 — Timeliness and method of Medicaid claim or other claim submission
A claim past that date is not late, it is unpayable, and no appeal recovers it. It is the one queue where a week of nobody working it is money that does not come back — which is the argument for working NJ FamilyCare as its own queue rather than mixing it into commercial follow-up. Every state’s limit is listed here.
Working New Jersey hours
New Jersey runs on Eastern time, 10 hours behind our floor in Rawalpindi. To be at a desk for your nine to five, the shift here runs 7pm to 3am, and 6pm to 2am once the clocks go forward. Pakistan does not observe daylight saving, so the shift moves on this side rather than yours.
That is the part that decides whether follow-up happens at all: a payer’s phone lines are open on New Jersey hours and nobody else’s.
What it costs in New Jersey
$1,850
Per seat, per month, in US dollars — $22,200 a year for one full-time person, forty hours a week, on New Jersey hours. No annual contract, no percentage of collections, no setup fee and no software to buy. Seat prices across all roles in New Jersey run $1,600 to $2,700; the full list is published.
That is the entire invoice. Run your own figures against a percentage vendor or a hire rather than take ours.
Getting started in New Jersey
About a week from a signed agreement to a person working your queue, and that week of training on your workflow is not billed on top. The work happens in your own system under a login you issue, so there is nothing to migrate and nothing to install. The week, step by step, and what is signed before anyone has access.
Questions
Do you work with New Jersey practices?
Yes. New Jersey accounts are worked during New Jersey office hours rather than queued overnight, because a payer's phone lines are open then and at no other time.
What is different about New Jersey?
NJ FamilyCare runs through managed care organizations with their own enrollment queues.
How long do we have to file a NJ FamilyCare claim?
1 year from the date of service (non-institutional); 1 year from discharge (inpatient), measured from the date of service. A denied claim: within one year of the date of service or 30 days of adjudication, whichever is later. Past that date a claim is not late, it is unpayable, and no appeal recovers it. Source: N.J.A.C. 10:49-7.2 — Timeliness and method of Medicaid claim or other claim submission.
When does a New Jersey payer have to pay a clean claim?
30 calendar days for electronic clean claims; 40 calendar days for paper (non-electronic) clean claims. Interest accrues from day 31 / day 41. A claim sitting past that is not merely late, it is late against a statute, and the follow-up call changes from "when might this be paid" to "this passed your statutory window on a specific date".
How much does medical billing cost in New Jersey?
$1,850 per seat per month — $22,200 a year for a full-time person, forty hours a week. Every seat price is published at softhomeglobal.com/pricing.
What hours will somebody actually be working our New Jersey queue?
New Jersey is on Eastern time, 10 hours behind Rawalpindi. The shift here runs 7pm to 3am so your seat is at a desk for your full working day, shifting to 6pm to 2am while daylight saving is in force — Pakistan does not observe it, so the change happens on our side.
Do you handle NJ FamilyCare as well as commercial payers?
Yes, and as its own queue rather than mixed into commercial follow-up. NJ FamilyCare has its own submission path, its own filing window and its own appeal route, and working it in the same worklist as commercial claims is how the deadlines get missed.
Is this a percentage of what you collect?
No — a flat monthly rate per seat, published at softhomeglobal.com/pricing. A percentage bills you most in your best month and points the vendor at the easy accounts.
What is the minimum commitment, and how quickly can somebody start?
One seat for one month, cancellable on thirty days notice, and about a week from a signed agreement to a person working your queue. The week of training is not billed. The steps are at softhomeglobal.com/how-it-works.
Is our patient data safe offshore?
A Business Associate Agreement is signed before anyone has access, and the work happens in your own system under a login you issue, so every action is attributable to a person in your audit trail. The controls are listed at softhomeglobal.com/security.
More for New Jersey
Next step
One seat on your New Jersey work
Twenty minutes on a call is enough to tell whether this fits. If it does not, I will say so.
Or write to ops@softhomeglobal.com