Personal Injury Protection Information For New Jersey

In accordance with the auto insurance claims requirements for the State of New Jersey, documents and information related to GEICO New Jersey's Decision Point Review Plan can be reviewed on this page. Please take note of information for losses before October 1, 2012 and on or after October 1, 2012.

During the COVID-19 pandemic, we will consider the use of Telemedicine and Telehealth, including the use of telephone-only communications to establish a physician-patient relationship as well as the use of telehealth for the diagnosis, treatment, ordering of tests, and prescribing medications, in accordance with our Decision Point Review Plan. Please check New Jersey Bulletin 20-19 to learn more.

By Order of the New Jersey Department of Banking and Insurance, Order No. A16-101, providers must submit all Decision Point Review and Pre-Certification requests on the uniform Attending Provider Treatment Plan form for requests related to injured insureds' NJ Personal Injury Protection benefits. You can access the form here .

Effective April 17, 2017, all providers treating PIP patients must use the Uniform Pre-Service and Post-Service Appeal Forms to submit Internal Appeals to Insurers. You can access the forms here: NJ Pre-Service Appeal form and NJ Post-Service Appeal form .

For Losses Occurring On Or After October 1, 2012

In accordance with the auto insurance claims requirements for the State of New Jersey, documents related to GEICO New Jersey's Decision Point Review Plan can be reviewed below:

Updated Documents, Effective October 1, 2021:

• Decision Point Review & Pre-Certification Requirements
• Dear Patient and Dear Provider Letter
• GEICO Assignment of Benefits (AOB)

All Decision Point Review and Pre-Certification requests are to be submitted to GEICO's vendor, ISG the administrator of GEICO New Jersey's Decision Point Review and Pre-Certification process.

Mailing Instructions

All Decision Point Review, Pre-Certification, and Internal Appeals

All documents related to decision point review, pre-certification, and internal appeals should be submitted to:

ISG
P.O. Box 1247
Daphne, AL 36526

Phone Number: (877) 308-6599
Fax Number: (866) 257-2323

All Other Mail, Including Medical Bills

Please continue to send all other documents for claims handled by GEICO Insurance companies in New Jersey, regardless of the date of loss, to:

GEICO
P.O. Box 9515
Fredericksburg, VA 22403-9515

Fax Number: (516) 213-1484

For Losses Occurring Before October 1, 2012

Updated Documents, Effective April 17, 2017:

• Decision Point Review & Pre-Certification Requirements
• Personal Injury Protection Plan Administration for patients
• Personal Injury Protection Plan Administration for medical providers

All Decision Point Review and Pre-Certification requests are to be submitted to GEICO's vendor, Prizm, LLC , the administrator of GEICO New Jersey's Decision Point Review and Pre-Certification process.

Mailing Instructions

All Decision Point Review, Pre-Certification, and Internal Appeals

All documents related to decision point review, pre-certification, and internal appeals should be submitted to:

Prizm, LLC
1015 Briggs Road
Suite 100
Mt. Laurel, NJ 08054

Phone Number: (856) 596-5600
Fax Number: (856) 596-6300
Email Address: Documents@Prizmllc.com

All Other Mail, Including Medical Bills

Please continue to send all other documents for claims handled by GEICO Insurance companies in New Jersey, regardless of the date of loss, to:

GEICO
P.O. Box 9515
Fredericksburg, VA 22403-9515

Fax Number: (516) 213-1484

Application Of Co-payments And Deductibles

In accordance with new regulations adopted by the New Jersey Department of Banking and Insurance pursuant to the application of penalty co-payments set forth in N.J.A.C. 11:3-4.4, GEICO applies co-payments and deductibles in the following order:

For losses occurring before October 1, 2012:

1. Insured Deductible
2. Insured Co-Payment
3. Penalty Co-Payments (if applicable)

For losses occurring on or after October 1, 2012:

1. Penalty Co-payments (if applicable)
2. Insured Deductible
3. Insured Co-payment