External review in New Jersey: deadline, cost and how to ask
New Jersey runs its own independent review of denials: Independent Health Care Appeals Program (IHCAP) external appeal. You generally have 4 months to ask for it.
External review means a doctor or reviewer outside your plan decides again. Internal appeal means your plan looks at its own decision again.
Checked against official sources: October 30, 2026.
Appeal deadlines are strict. If you are near a deadline or your care is urgent, call free help today.
Step 2: Outside review in New Jersey
- Program
Independent Health Care Appeals Program (IHCAP) external appeal
- Who runs it
- NJ Department of Banking and Insurance, through its contracted independent utilization review organization (IURO), Maximus Federal: Fully-insured health plans issued in New Jersey, and NJ FamilyCare (Medicaid) managed care plans
- Deadline to ask
4 months
You must typically file within 4 months of receiving the decision on your internal appeal. If you are in NJ FamilyCare (Medicaid), you have 60 days from receipt of the plan's internal appeal decision.
- The deadline runs from
Your receipt of the plan's decision on your internal appeal
- Do I have to appeal to my plan first?
You usually must finish the plan's internal appeal first. You can go straight to external appeal if the plan missed its internal appeal time limits, if the plan waived the internal review, or if you ask for an expedited internal appeal and an expedited external appeal at the same time.
- How long the review takes
Urgent: 48 hours
- Cost
There is no fee. A 2025 law removed the filing fee, and the plan (carrier) pays the cost of the review.
- What can be reviewed
Utilization management denials: care or payment denied, reduced or ended as not medically necessary, experimental or investigational, cosmetic, dental rather than medical, or for an excluded pre-existing condition, and denied requests to see an out-of-network provider when the network has no qualified provider (in-plan exception). Not eligible: self-funded plans, Medicare and Medicare Advantage, plans issued in another state, and services that are not covered under the plan's terms.
- Is the decision final?
The decision is binding on you and the plan, except where other remedies are available under state or federal law.
- How to ask
Apply online at njihcap.maximus.com, or print the form there (or ask Maximus to mail or fax one) and send it by fax to 585-425-5296 or by mail to Maximus Federal – NJ IHCAP, 3750 Monroe Avenue, Suite 705, Pittsford, NY 14534. Attach copies of the plan's Stage 1 and/or Stage 2 decisions, the plan's initial denial, the summary of coverage from your member handbook or certificate, your medical records and letters, and a signed consent and medical-records release (needed if your provider files for you). Send copies only; originals are not returned.
Law: DOBI Semi-Annual IHCAP Report (Jan.-June 2025); N.J.S.A. 26:2S-11, 26:2S-12 (as amended by P.L.2025, c.75)
- Forms and online request
- Phone
Maximus Federal 888-866-6205; DOBI IHCAP 1-888-393-1062
Write my appeal: free letters
Sources
The official sources for New Jersey are listed on the New Jersey page.