New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 23 - THIRD-PARTY ADMINISTRATORS
Subchapter 5 - THIRD-PARTY BILLING SERVICES
Section 11:23-5.4 - Approval of certification application; standards

Universal Citation: NJ Admin Code 11:23-5.4

Current through Register Vol. 56, No. 18, September 16, 2024

(a) The Commissioner may approve an application for certification as a third party billing service if he or she finds that the applicant meets the standards established by the Act, including, but not limited to, the following:

1. All of the information required by the Act, these rules or by the Commissioner has been filed;

2. The persons responsible for conducting the applicant's affairs are competent, trustworthy and possess good reputations, and have appropriate experience, training and education;

3. The applicant has demonstrated the ability to ensure that its services will be performed in a manner which will result in the efficient operation of its business, including, if the applicant accepts payments from benefits payers on behalf of its clients, appropriate financial controls;

4. The standard contract forms to be used by the applicant are acceptable; and

5. The applicant has adequate arrangements for complying with the provisions of 17B:30-23 et seq. and N.J.A.C. 11:22-3.

(b) Prior to approving an application, the Department may request that an applicant provide, in writing, any additional information that the Department deems necessary to consider the application. Failure by an applicant to provide the requested information to the Department within 45 days from the date of the Departments written request shall result in an application being deemed withdrawn without further notice.

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