New Jersey § 17B:30-55.8 Prior authorization, denial, limitation imposed by payer, physician, scope of actions.

New Jersey Statutes

§ 17B:30-55.8 — Prior authorization, denial, limitation imposed by payer, physician, scope of actions.

New Jersey § 17B:30-55.8

Title 17BINSURANCE

This text of New Jersey § 17B:30-55.8 (Prior authorization, denial, limitation imposed by payer, physician, scope of actions.) is published on Counsel Stack Legal Research, covering New Jersey primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

N.J. Stat. Ann. § 17B:30-55.8 (2026).

Text

9. Any denial of a request for prior authorization or limitation imposed by a payer on a requested service on the basis of utilization management determination shall be made by a physician who shall: a. make the adverse determination under the clinical direction of a medical director of the payer who shall:

(1)be licensed in this State; and (2) strictly follow a medical policy that has been developed and made available in accordance with P.L.2023, c.296 (C.17B:30-55.1 et al.) and the "New Jersey Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.); b. not be compensated by a payer based on the approval or denial rate of the reviewing physician; and c. not be provided preferential treatment by a payer in the requests for prior authorization of the reviewing physician if that physi

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9. Any denial of a request for prior authorization or limitation imposed by a payer on a requested service on the basis of utilization management determination shall be made by a physician who shall: a. make the adverse determination under the clinical direction of a medical director of the payer who shall: (1) be licensed in this State; and (2) strictly follow a medical policy that has been developed and made available in accordance with P.L.2023, c.296 (C.17B:30-55.1 et al.) and the "New Jersey Health Care Quality Act," P.L.1997, c.192 (C.26:2S-1 et seq.); b. not be compensated by a payer based on the approval or denial rate of the reviewing physician; and c. not be provided preferential treatment by a payer in the requests for prior authorization of the reviewing physician if that physician is also a network provider for the payer. L.2023, c.296, s.9.