52:17B-198 Joint negotiations regarding non-fee related matters.
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/nj/title-52/chapter-17b/52-17b-198·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
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.