New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 23 - THIRD-PARTY ADMINISTRATORS
Subchapter 5 - THIRD-PARTY BILLING SERVICES
Section 11:23-5.9 - Suspension or revocation of certification; grounds
Universal Citation: NJ Admin Code 11:23-5.9
Current through Register Vol. 56, No. 6, March 18, 2024
(a) The Commissioner may suspend or revoke a certification issued pursuant to the Act if he or she finds that the third party billing service:
1. Is using methods or practices in the
conduct of its business that render its further transaction of business in this
State hazardous or injurious to its clients or to the public;
2. Has failed to pay any judgment rendered
against it within 60 days after the judgment has become final;
3. Has violated any lawful rule or order of
the Commissioner or any provision of the laws of this State;
4. Has, without just cause, refused or failed
to perform services arising under its contracts with clients;
5. Has been convicted of, or has entered a
plea of guilty or nolo contendere to a felony or crime of the first, second or
third degree in this State, without regard to whether adjudication was
withheld; or
6. Has had its
credential as a third party billing service suspended, revoked or non-renewed
for cause in another State.
(b) If the Commissioner finds that one or more grounds exist for the suspension or revocation of a certification issued under the Act, the Commissioner may, in lieu of or in addition to suspension or revocation, impose a fine upon the third party billing service.
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