New Jersey Personal Injury Protection: Decision Point Review and Pre-Certification

NOTICE: ARCHIVED GEICO NJ Decision Point Review and Pre-Certification Plans prior to 2/18/27 are located here.

This page provides forms, plan documents, network information, and submission instructions applicable to claims for New Jersey Personal Injury Protection (“PIP”) benefits. Providers and eligible injured persons should review the applicable Decision Point Review Plan before requesting treatment, services, testing, equipment, or supplies.

Required Forms

Under New Jersey Department of Banking and Insurance Order No. A16-101, providers must submit Decision Point Review and Pre-Certification requests concerning New Jersey PIP benefits on the uniform Attending Provider Treatment Plan Form. Providers submitting internal appeals must use the applicable uniform Pre-Service Appeal Form or Post-Service Appeal Form.

Plan Documents Effective February 18, 2027

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

Medlogix administers GEICO New Jersey’s Decision Point Review and Pre-Certification process.

Submission Instructions

Voluntary Networks

Mitchell International, Inc has established networks of pre-approved vendors that can be recommended for the provision of certain diagnostic services, including Magnetic Resonance Imaging (MRI), Computer Assisted Tomography (CT/CAT Scans), Needle Electromyography (needle EMG), H-reflex and nerve conduction velocity (NCV) tests, Somatosensory Evoked Potential (SSEP), Visual Evoked Potential (VEP), Brain Audio Evoked Potential (BAEP), Brain Evoked Potential (BEP), Nerve Conduction Velocity (NCV), H reflex Study, Electroencephalogram (EEG), Durable Medical Equipment with a cost or monthly rental in excess of $50, USFDA approved Prescription Drugs, and Services, equipment or accommodations provided by an ambulatory surgery facility, except when performed together by the treating physician.

An exception from the network requirement applies for any of the electro-diagnostic tests performed in N.J.A.C. 11:3-4.5b1-3 when done in conjunction with a needle EMG performed by the treating provider.

The Insured/Eligible Injured Person may elect to obtain these services from one of the pre-approved vendors. If they use a pre-approved vendor from one of these networks for medically necessary goods or services, they will be fully reimbursed or paid at the allowable contract rate pursuant to any PPO contract for those goods and services consistent with the policy.

Those Insureds/Eligible Injured Persons who chose not to utilize these networks will be assessed an additional co-payment of thirty percent (30%) of the eligible charge. This includes durable medical equipment to be supplied to an Insured/Eligible Injured Person by an ambulatory surgery facility or hospital for use during and/or post surgery. A list of the voluntary networks available are outlined below:

Application of Co-Payments and Deductibles

Consistent with N.J.A.C. 11:3-4.4, GEICO applies applicable deductibles and co-payments in the following order:

1. Penalty co-payment, if applicable
2. Insured deductible
3. Insured co-payment

PPO Networks

In addition, for testing, services, and supplies not identified above, we make available preferred provider organization (PPO) networks that include providers in all specialties, hospitals, outpatient facilities, and urgent care centers throughout the entire State of New Jersey. The use of a provider for these services is strictly voluntary and is provided as a service to the Insured/Eligible Injured Persons. A penalty co-payment will not be applied if you choose to select a health care provider for these services outside of the available preferred provider organization (PPO) networks. The pre-approved vendor networks listed below may be contacted to access the PPO networks available for these services.

Electronic Billing Clearinghouse for Medical Providers

GEICO accepts electronic billing from providers in accordance with N.J.S.A. 39:6A-5.4(a).

Please contact our electronic billing (EDI) vendor Carisk Intelligent Clearinghouse at (888) 207-6366 or visit www.cariskic.com for information about arranging electronic billing with GEICO.