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2 N.J.A.R. 196

Hudson County Medical Assistance Unit; Bergen Ambulance Services v
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Citation: 2 N.J.A.R. 196
Decision Date: 1980
Agency: DIVISION OF MEDICAL ASSISTANCE
Synopsis: Bergen Ambulance Services requested a hearing after the administrator of the Hudson County Medical Assistance Unit denied payment for 20 claims submitted by the service because they were 'neither prior authorized nor submitted within the required five-day period following the rendering of the services .... ' The administrative law judge found that while the service did not dispute its failure to file its claims within the prescribed time period, this was the first instance in which the medical assistance unit had strictly applied the time limitations. Under the circumstances, the judge concluded that the denial of the claims was arbitrary and unreasonable. Accordingly, the medical assistance unit was ordered to pay the claims while the ambulance service was put on notice that all future claims would have to be filed within the specified time periods.
Rule(s) Cited: 10:82-1.8 10:82-3.1