Get Nj Direct Claim Form

The NJ Direct Claim Form is an important document used for submitting healthcare claims under the State Health Benefits Program and School Employees’ Health Benefits Program. This guide will provide you with clear, step-by-step instructions to help you fill out the form efficiently and accurately online.

Follow the steps to complete your claim form online.

1. Press the ‘Get Form’ button to download the NJ Direct Claim Form and open it in your preferred editor.
2. Begin by entering the subscriber's information in the designated fields. This includes entering the last name, first name, date of birth, sex, identification number, address, telephone number, employer's name, and plan name.
3. Indicate if you have other health coverage. If 'Yes,' be prepared to complete items 20 to 26 regarding other coverage details.
4. If the patient is different from the subscriber, fill in the patient's information, including their last name, first name, date of birth, sex, telephone number, and address.
5. Specify the patient’s relationship to the insured and their employment status. Mark if the condition is related to employment, auto accident, or other accidents.
6. Fill in the date of the current illness or injury and address other health coverage information by completing items 20 to 26, ensuring you enter the required details for the other insurer.
7. Review and sign the authorization section, confirming that the information provided is complete and accurate.
8. Finally, save your completed claim form. You have the option to download, print, or share the form for submission.

Take the first step in managing your healthcare claims by completing the NJ Direct Claim Form online today.