Bill > S3799

Introduced Session

This bill makes changes to the existing health insurance carrier credentialing process to facilitate transparency and enforcement. First, the bill requires a carrier committee reviewing a credentialing application to notify the applicant within 30 days following submission of the application whether the application is incomplete. If the committee does not notify the applicant of an incomplete application within 30 days, the application is to be deemed complete. In addition, the bill requires carriers to include on their Internet websites the universal participation and renewal forms and an explanation of the credentialing process, including a list of all the documents required for participation and renewal and any expected timelines. The bill also provides that if a physician, while waiting to receive a credential to participate in the provider network of a carrier, is delivering health care services to covered persons within the network, the carrier is required to reimburse the physician for services delivered as of the date the credentialing application was filed, if the application is approved by the carrier. Under the bill, carriers are prohibited from requiring a physician who is already credentialed with the carrier and who changes employers or health care facilities within this State to submit a new application or renewal form to participate in the carrier's network solely on the basis that the physician changed employers or health care facilities. Lastly, the bill authorizes the Department of Banking and Insurance to receive, investigate, and enforce alleged violations of law relating to the credentialing process.

Committee Categories

Gordon Johnson (D)*,  Shirley Turner (D)*,  Tony Bucco (R),  Nilsa Cruz-Perez (D),  Joe Cryan (D),  Patrick Diegnan (D),  Linda Greenstein (D),  Paul Moriarty (D),  Bob Singer (R), 

Senate Commerce Hearing (10:00:00 3/24/2025 Committee Room 1, 1st Floor, State House Annex, Trenton, NJ) (on 03/24/2025)

Official Document