§ 17B:30-61 — Third party access.

New Jersey § 17B:30-61

• Jurisdiction: New Jersey
• Title 17B: INSURANCE

Text

2. a. A contracting entity shall not grant to a third party access to a provider network contract, or a provider's dental services or contractual discounts, or both, pursuant to a provider network contract, unless the contracting entity meets the requirements of subsections b. and c. of this section. b. A dental carrier may grant access to its provider network contract to a third party if, at the time the contract is entered into, and at any time the contract is renewed, the dental carrier allows any provider which is part of the carrier's provider network to choose not to participate in third party access to the contract. The third party access provision of any provider contract shall be clearly identified in the provider contract. A dental carrier shall not grant third party access to the contract of any provider that does not participate in third party access. c. A contracting entity may grant a third party access to a provider network contract, or services or discounts pursuant to a provider network contract, if: (1) The contract specifically states that the contracting entity may enter into an agreement with third parties allowing the third parties to obtain the contracting entity's rights and responsibilities as if the third party were the contracting entity, and when the contracting entity is a dental carrier, the provider chose to participate in third party access at the time the provider network contract was entered into or renewed; (2) The third party accessing the contract agrees to comply with all of the contract's terms; (3) The contracting entity identifies, in writing or electronic form to the provider, all third parties in existence as of the date the contract is entered into or renewed; (4) The contracting entity includes on its website a listing, updated no less frequently than every 90 days, identifying all third parties; (5) The contracting entity requires each third party to identify the source of the discount on all remittance advices or explanations of payment under which a discount is taken , except this requirement shall not apply to electronic transactions mandated under the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191; (6) The contracting entity notifies the third party of the termination of a provider network contract no later than 30 days from the termination date with the contracting entity; (7) A third party ceases its right to a provider's discounted rate as of the date of termination of the provider's contract with the contracting entity; and (8) The contracting entity delivers to participating providers a copy of the provider network contract relied on in the adjudication of a claim within 30 days after the date of a request from the provider. d. No provider shall be bound by or required to perform dental treatment or services under a provider network contract that has been granted to a third party in violation of this act. L.2019, c.254, s.2.