Bill

Bill > A2012


NJ A2012

NJ A2012
"New Jersey Respect for Physicians Act;" requires prompt response by insurers to requests for prior authorization of health care services.


summary

Introduced
01/14/2020
In Committee
01/14/2020
Crossed Over
Passed
Dead
01/11/2022

Introduced Session

2020-2021 Regular Session

Bill Summary

This bill, entitled the "New Jersey Respect for Physicians Act" amends the "Health Claims Authorization, Processing and Payment Act" to require health insurance carriers to contact the hospital and physician within four hours to discuss a decision to authorize certain health care services and to reduce the amount of time in which a carrier must respond to requests for prior authorization. In the case of a request for prior authorization for a covered person who will be receiving inpatient hospital services or health care services in an outpatient or other setting, current law requires the insurance carrier to communicate the denial of the request or the limitation imposed on the requested service to the hospital or physician within a time frame appropriate to the medical exigencies of the case, but no later than 15 days following the time the request was made. This bill would reduce that to a time frame appropriate to the medical exigencies of the case but no later than 48 hours following the time the request was made. The bill similarly reduces the amount of additional time permitted if the payer needs additional information. With respect to authorizations for a covered person who is currently receiving inpatient hospital services or care rendered in the emergency department of a hospital, the law would remain the same and a denial or limitation shall be communicated no later than 24 hours following the time the request was made.

AI Summary

This bill, entitled the "New Jersey Respect for Physicians Act," amends the "Health Claims Authorization, Processing and Payment Act" to require health insurance carriers to respond more promptly to requests for prior authorization of healthcare services. The bill reduces the maximum time frame for insurance carriers to respond to prior authorization requests for inpatient hospital services or outpatient healthcare services from 15 days to 48 hours, with an additional 48 hours if the carrier needs more information. For patients currently receiving inpatient hospital or emergency department services, the carrier must respond within 24 hours. The bill also requires insurance carriers to make reasonable attempts to contact the hospital and physician by phone within four hours of receiving a prior authorization request.

Committee Categories

Business and Industry

Sponsors (2)

Last Action

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 01/14/2020)

bill text


bill summary

Loading...

bill summary

Loading...
Loading...