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Covered medical services must be medically necessary and causally related to the motor vehicle accident. The plan describes how claims are processed under the Automobile Cost Reduction Act of 1998, including Decision Point Review and Pre-Certification requirements, penalties for noncompliance, and the eligible process for submitting treatment plan requests.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/personal-injury-protection-pip-decision-point-review-and-pre-certification-plan/385405/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/personal-injury-protection-pip-decision-point-review-and-pre-certification-plan/385405.png","ImageObject",442,249,{"name":88,"@type":89},"วิน","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-08","2026-09-24",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"What does PIP cover in an auto policy?","Question",{"text":108,"@type":109},"PIP covers medical expenses resulting from the motor vehicle accident, limited by the policy’s terms and fee schedules. The expenses must be medically necessary and causally related to the accident.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What is Decision Point Review and when is it used?",{"text":113,"@type":109},"Decision Point Review occurs at defined intervals within Care Paths to evaluate whether treatment should continue or change. At those decision points, eligible injured persons or providers provide information to Premier Prizm about intended further treatment.",{"name":115,"@type":106,"acceptedAnswer":116},"Which diagnostic tests and services require Pre-Certification?",{"text":117,"@type":109},"Certain diagnostic tests and specified treatments or services require pre-authorization under the PreCertification Plan. Failure to precertify may lead to penalties or co-payments even when services are medically necessary.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},385405,1791363644,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":135,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":76},2336475104736,"https://ap-avatar.wpscdn.com/avatar/22000c4c5e0e5b17e70?x-image-process=image/resize,m_fixed,w_180,h_180&k=1786591360781797222","PO Box 9515  \nFredericksburg, VA 22403-9515  \nCompany Name:  \nClaim Number:  \nLoss Date:  \nPolicyholder:  \nPremier Prizm Acct No.:  \nInjured Party:  \nDear :  \nPersonal Injury Protection (PIP) is the portion of the auto policy that provides coverage for medical expenses. These medical expenses are subject to policy limits, deductibles, co-payments and any applicable medical fee schedules. Additionally, these medical expenses must be for services that are deemed medically necessary and causally related to the motor vehicle accident. With the adoption of the Automobile Cost Reduction Act of 1998, several important changes have been made in the way a claim is processed. Additional information regarding Decision Point Review/Pre-Certification can be accessed on the Internet atthe New Jersey Department of Banking and Insurances website at [http://www.nj.gov/dobi//filings.htm](http://www.nj.gov/dobi//filings.htm).  \nPremier Prizm Solutions LLC has been selected by Company Name to implement their plan as required by the Automobile Cost Reduction Act. Premier Prizm will review treatment plan requests for Decision Point Review/Pre-Certification, perform Medical Bill Repricing and Audits of provider bills, coordinate Independent Medical Exams and Peer Reviews, and provide Case Management Services.  \nIf certain medically necessary services are performed without notifying Company Name or Premier Prizm, a penalty/co-payment may be applied. Medical care rendered in the first 10 days following the covered loss or any care received during an emergency situation is not subject to Decision Point Review/Pre-certification.  \nThe Plan Administrator is Premier Prizm Solutions LLC.  \nMailing Instructions:  \nAll Decision Point Review, pre-certification and internal appeals related documents are to be submitted to:  \nPremier Prizm Solutions, LLC  \n10 East Stow Road  \nSuite 100  \nMarlton, New Jersey 08053  \nPhone Number: 856-596-5600  \nFax Number: 856-596-6300  \n[Email Address](Email Address AICRA@PremierPrizm.com)[ AICRA@PremierPrizm.com](Email Address AICRA@PremierPrizm.com)  \n1  \nEP0052(08-12)  \nAll other mail is to be submitted to:  \nGEICO  \nP.O.Box 9515  \nFredericksburg, VA 22403  \nFax Number: 516-213-1484  \nSubmission of Treatment Plan Requests for Decision Point Review/Pre-Certification  \nPlease bring the “Attending Provider Treatment Plan” form to your treating provider for completion. This completed form along with any applicable medical documentation should be forwarded to Premier Prizm by fax (856-596-6300), or mail (10 East Stow Road, Suite 100 Marlton, NJ 08053) or email to [TreatmentRequests@PremierPrizm.com. This](TreatmentRequests@PremierPrizm.com. This) form can be accessed on Premier Prizm’s web site at [www.PremierPrizm.com](www.PremierPrizm.com. Any questions)[. Any questions](www.PremierPrizm.com. Any questions) regarding your treatment request can be directed to Premier Prizm at 856-596-5600 during regular business hours of Monday through Friday 8:00 AM to 5:00 PM, EST except for Federally Declared Holidays.  \nDecision Point Review  \nPursuant to N.J.A.C. 11:3-4, the New Jersey Department of Banking and Insurance has published standard courses of treatment, known as Care Paths, for soft tissue injuries, collectively referred to as Identified Injuries. Additionally, guidelines for certain diagnostic tests have been established by the New Jersey Department of Banking and Insurance according to N.J.A.C. 11:3-4 . Decision Points are intervals within the Care Paths where treatment can be evaluated for a decision about the continuation or choice of further treatment. At Decision Points, the eligible injured person or the health care provider must provide Premier Prizm with information regarding further treatment the health care provider intends to provide.  \nIn accordance with N.J.A.C. 11:3-4.5, the administration of any of the following diagnostic tests is subject to Decision Point Review, regardless of diagnosis.  \nDiagnostic Tests whic","cbCaiu9xZIV3IPvP","https://ap.wps.com/l/cbCaiu9xZIV3IPvP","pdf",270174,7,"English","# Submission of Treatment Plan Requests for Decision Point Review/Pre-Certification\n## Required attending provider treatment plan completion\n## Submission methods and contact hours\n# Decision Point Review\n## Care Paths and Decision Points\n## Diagnostic tests subject to Decision Point Review\n# Pre-Certification\n## Pre-authorization requirements and potential penalties\n## Covered treatment and services requiring pre-certification","[{\"question\":\"What does PIP cover in an auto policy?\",\"answer\":\"PIP covers medical expenses resulting from the motor vehicle accident, limited by the policy’s terms and fee schedules. The expenses must be medically necessary and causally related to the accident.\"},{\"question\":\"What is Decision Point Review and when is it used?\",\"answer\":\"Decision Point Review occurs at defined intervals within Care Paths to evaluate whether treatment should continue or change. At those decision points, eligible injured persons or providers provide information to Premier Prizm about intended further treatment.\"},{\"question\":\"Which diagnostic tests and services require Pre-Certification?\",\"answer\":\"Certain diagnostic tests and specified treatments or services require pre-authorization under the PreCertification Plan. Failure to precertify may lead to penalties or co-payments even when services are medically necessary.\"}]","Personal Injury Protection (PIP) - Decision Point Review and Pre-Certification Plan | PDF",1790268863]