New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 22 - HEALTH BENEFIT PLANS
Subchapter 1 - PROMPT PAYMENT OF CLAIMS
Section 11:22-1.12 - External appeals-alternative payment dispute resolution-dental plan organizations and dental service corporations
Current through Register Vol. 56, No. 24, December 18, 2024
(a) Every dental plan organization and dental service corporation shall offer an independent, external alternative payment dispute resolution (ADR) mechanism to participating health care providers to review adverse decisions of its internal appeals process.
(b) Dental plan organizations and dental service corporations shall annually notify participating providers in writing, or by posting on their websites, of the internal appeals process and the ADR mechanism and how they can be utilized.
(c) Dental plan organizations and dental service corporations shall annually report, in a format prescribed by the Department, the number of internal and external provider appeals received and how they were resolved.