45:9-42.41a. Clinical laboratory bills, presentation.
378 words·~2 min read·
/nj/title-45/chapter-9/45-9-42-41a·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
1. A clinical laboratory shall present or cause to be presented a claim, bill or demand for payment for clinical laboratory services directly to the recipient of the services, except that the claim, bill or demand for payment may be presented to any of the following:
a. An immediate family member of the recipient of the services or other person legally responsible for the debts or care of the recipient of the services;
b. A third party payer including a health insurer, a health, hospital or medical services corporation, a State approved or federally qualified health maintenance organization in which the recipient of the services is enrolled, a governmental agency or its specified agent which provides health care benefits on behalf of the recipient of the services, and an employer of the recipient of the services who is responsible for payment of the services, provided that billing these payers is consistent with the terms of any applicable contract between the payer and the recipient of the services;
c. A hospital or skilled nursing facility in which the recipient of the services is or has been an inpatient or outpatient;
d. A substance use disorder program in which the recipient of the services is or has been a participant; and
e. A nonprofit clinic or other health care provider whose purpose is the promotion of public health, from which the recipient of the services has received health care.
Upon the request of the health care provider who requested the clinical laboratory services, a clinical laboratory shall notify the health care provider of the amount of the claim, bill or demand for payment that was presented to the recipient or the recipient's responsible third party pursuant to this section.
Notwithstanding the provisions of this section to the contrary, in the case of a clinical laboratory which performs services at the request of another clinical laboratory, the clinical laboratory may present the claim, bill or demand for payment to the requesting clinical laboratory.
Notwithstanding the provisions of this section to the contrary, nothing in this section shall affect a contractual agreement between a clinical laboratory and a third party payer regarding presentation of a claim, bill or demand for payment directly to that third party payer.
L.1997,c.156,s.1; amended 2023, c.177, s.136.