Phase III: Claims Litigation

  • Once the administrative appeals process is fully exhausted, the provider and/or patient can sue for benefits due and owing to a patient or provider holding a valid assignment of benefits with the patient.
  • NJDPA members will enjoy the added benefit of having a streamlined and cost-effective process, which is specifically designed to put individual members in the best possible position when facing the decision to litigate. 
  • Each payment dispute may be different depending on the factual disposition of the case at the administrative level. 
  • Our legal partners have developed strong litigation experience in leveraging various state and federal laws such as ERISA to arm out-of-network providers with viable legal claims designed to place real pressure on payors to pay what is reasonably owed to providers for services actually rendered. 
  • Going even further, to the extent that a given NJDPA member wishes to become a participating provider but has been stonewalled in obtaining access to a given provider network or contract, our legal partners have assisted a multitude of providers in obtaining network access through legal means. 

Return to Phase II

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  • Phillip Kim
    commented 2018-06-11 09:52:31 -0400
    Has anyone dealth with a company called “Data I Sight” for Cigna claims? Looks like Cigna is sending it out to a repricing company to knock down the allowed rate without negotiation option. If so, what can we do about it?