New Jersey: Start Here
Beginner guide for New Jersey—Get Covered NJ, DOBI/IHCAP external review, ETPAA PA & UM appeal deadlines.
Read guideState playbook
New Jersey
State insurers, legislation, and appeal resources for patients and advocates in New Jersey.
4 guides
New Jersey Prior Authorization Law
ETPAA (P.L. 2023, c.296)—ePA 24h/72h, outpatient PA 9–12 days, deemed authorized, 180-day chronic PA.
Read guideNew Jersey Health Insurance Appeals and Grievances
Appeal within 180 days—30-day decision, 72-hour expedited, path to DOBI IHCAP external review.
Read guideNew Jersey External Review (DOBI / IHCAP)
Binding on carrier—four-month filing, 45-day IURO decision, 48-hour expedited, Maximus portal.
Read guidePrior auth & internal appeals
Match the plan on the member ID card. Use the denial letter for where to file appeals.
- Horizon Blue Cross Blue Shield of New Jersey
- AmeriHealth Insurance Company of New Jersey
- Oscar Health
- Ambetter from WellCare of New Jersey
- UnitedHealthcare
- Get Covered New Jersey (Marketplace)
- NJ FamilyCare (Medicaid)
External appeals
After internal appeal, for eligible New Jersey fully insured plans only.
- DOBI — Independent Health Care Appeals Program (IHCAP)
- Medicaid — fair hearing