17:48G-4 Inapplicability of act relative to certain decisions of insurers, third party administrators.
135 words·~1 min read·
/nj/title-17/chapter-48g/17-48g-4·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
7. This act shall not be construed:
a. To regulate insurers' or third party administrators' making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;
b. To regulate insurers' or third party administrators' use of a protocol for denying or limiting benefit payments for dental services where the protocol:
(1)has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and
(2)does not involve evaluation of an individual patient's dental care or condition; or
c. To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviews.
L.2007, c.259, s.7.