New Jersey Administrative Code
Title 11 - INSURANCE
Chapter 6 - NEW JERSEY WORKERS' COMPENSATION MANAGED CARE ORGANIZATIONS
Subchapter 2 - NEW JERSEY WORKERS' COMPENSATION MANAGED CARE ORGANIZATIONS
Section 11:6-2.10 - WCMCO provider agreements

Universal Citation: NJ Admin Code 11:6-2.10

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

(a) No provider agreement or amendment thereto may be used until a copy of the form of agreement has first been filed with the Department of Banking and Insurance. Thereafter, the form of agreement may be used until or unless a disapproval is received from the Department.

(b) All forms of agreements and amendments shall be filed at least 60 days prior to the planned date of use, and shall include a unique identifying form number in the bottom left hand corner.

(c) Submission of amended forms of agreements shall include two copies of the amended agreement(s) or page(s). One copy shall be marked to show changes to the existing form, and one copy shall be unmarked.

(d) Agreements with providers shall state:

1. The term of the agreement;

2. The services and supplies to be provided by the provider and a list of the contractual amounts or rates that will be paid to the provider for those services and supplies;

3. That providers shall not discriminate in their treatment of covered persons;

4. That the provider will hold the covered person harmless for the cost of any service or supply for which the carrier or intermediary provides benefits, whether or not the provider believes its compensation for the service or supply from the carrier or intermediary is made in accordance with the reimbursement provision of the provider agreement, or is otherwise inadequate; and

5. That the providers shall maintain malpractice insurance coverage in an amount not less than $ 1,000,000 per occurrence and $ 3,000,000 in the aggregate.

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