§ 52:17B-198 — Joint negotiations regarding non-fee related matters.

New Jersey § 52:17B-198

• Jurisdiction: New Jersey
• Title 52: STATE GOVERNMENT, DEPARTMENTS AND OFFICERS

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3. Two or more independent physicians or dentists who are practicing in the service area of a carrier may jointly negotiate with a carrier and engage in related joint activity, as provided in this act, regarding non-fee-related matters which may affect patient care, including, but not limited to, any of the following: a. the definition of medical necessity and other conditions of coverage; b. utilization management criteria and procedures; c. clinical practice guidelines; d. preventive care and other medical management policies; e. patient referral standards and procedures, including, but not limited to, those applicable to out-of-network referrals; f. drug formularies and standards and procedures for prescribing off-formulary drugs; g. quality assurance programs; h. respective physician or dentist and carrier liability for the treatment or lack of treatment of covered persons; i. the methods and timing of payments; j. other administrative procedures, including, but not limited to, eligibility verification systems and claim documentation requirements for covered persons; k. credentialing standards and procedures for the selection, retention and termination of participating physicians or dentists; l. mechanisms for resolving disputes between the carrier and physicians or dentists, including, but not limited to, the appeals process for utilization management and credentialing determinations; m. the health benefits or dental plans sold or administered by the carrier in which the physicians or dentists are required to participate; n. the formulation and application of reimbursement methodology; o. the terms and conditions of physician or dentist contracts, including, but not limited to, all products clauses, and the duration and renewal provisions of the contract; and p. the inclusion or alteration of a contractual term or condition, except when the inclusion or alteration is required by a federal or State regulation concerning that term or condition; however, the restriction shall not limit a physician's or dentist's rights to jointly petition the federal or State government, as applicable, to change the regulation. L.2001,c.371,s.3; per s.15, act expires April 8, 2008.