Bill > A4973

Introduced Session

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

Committee Categories

Kimberly Eulner (R)*,  Marilyn Piperno (R)*, 

Introduced, Referred to Assembly Financial Institutions and Insurance Committee (on 12/12/2022)

Official Document