New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 24A - HEALTH CARE QUALITY ACT APPLICATION TO INSURANCE COMPANIES, HEALTH SERVICE CORPORATIONS, HOSPITAL SERVICE CORPORATIONS, AND MEDICAL SERVICE CORPORATIONS
Subchapter 4 - PROVISIONS APPLICABLE TO CARRIERS OFFERING ONE OR MORE HEALTH BENEFITS PLANS THAT ARE MANAGED CARE PLANS
Section 11:24A-4.7 - Provider application for participation
Current through Register Vol. 56, No. 6, March 18, 2024
(a) A carrier shall establish a committee to review applications submitted by licensed providers to become members of the carrier's network.
(b) The committee shall complete its review of a complete application within no more than 90 days of receipt of the complete application.
(c) The carrier may establish the factors to be considered by the committee in determining whether an application is complete and whether to accept or reject a complete application.
(d) The carrier may establish its own application forms, but if it does not elect to establish its own form, the carrier shall make available, upon request, a written notice of the information it requires to be submitted to determine an application is complete.
(e) All applications, notices and guidelines required by this section shall be reviewable upon request by the Department.