17B:30-55.9 Prior authorization, defined number, discrete services, set time frame, validity, exception.
143 words·~1 min read·
/nj/title-17b/chapter-30/17b-30-55-9·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
10. Except where shorter time frames are necessary to monitor patient safety or treatment effectiveness and with notice to the treating provider, prior authorization for a service which includes a defined number of discrete services within a set time frame shall be valid for purposes of authorizing the health care provider to provide care for a period of 180 days from the date the provider receives the prior authorization and a payer shall not revoke, limit, condition or restrict a prior authorization within that period if
(1)the covered person continues to be eligible for coverage;
(2)the clinical information provided at the time the prior authorization request was made has not been misrepresented by the treating physician or covered person; and
(3)there has not been a material change in the clinical circumstances or condition of the covered person.
L.2023, c.296, s.10.