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  • NJ A2472
  • Expands scope of claims subject to "Health Claims Authorization, Processing and Payment Act," and modifies certain claims procedures.
Introduced
(2/4/2016)
In Committee
(2/4/2016)
Crossed OverPassedSignedDead/Failed/Vetoed
2016-2017 Regular Session
This bill expands the scope of claims subject to sections 3 through 7 of the "Health Claims Authorization, Processing and Payment Act" (hereafter "claims act"), P.L.2005, c.352 (C.17B:30-50 through 17B:30-54), to include prompt authorization for claims involving benefits provided by occupational therapists, physical therapists, and speech-language pathologists. Further, regarding utilization management of all claims subject to the claims act, it requires that carriers and organized delivery systems, in addition to the utilization management information they already provide via Internet website pursuant to the act, include information concerning the computer algorithms and the development of such algorithms used to make utilization management decisions concerning the medical necessity of health care services. Finally, the bill, under section 4: - requires that any carrier or organized delivery system denial of, or limitation imposed upon, a request for authorization be made by a licensed health care provider in the same field of practice as the requesting health care provider; and - reduces the time frame under which a carrier or organized delivery system shall respond to a health care provider's request for authorization to provide services to a covered person, in those instances when the carrier or organized delivery system is initially unable to approve or deny a request for authorization because of the need for additional information, and requests this additional information from the health care provider. The carrier or organized delivery system, upon receipt of any additional information, shall respond within three days to the requesting health care provider, instead of the 15 days as currently provided under the law.
Financial Institutions and Insurance
Introduced, Referred to Assembly Financial Institutions and Insurance Committee  (on 2/4/2016)
 
 

Date Chamber Action Description
2/4/2016 A Introduced, Referred to Assembly Financial Institutions and Insurance Committee
Date Motion Yea Nay Other
None specified