Search Rutgers Law Library N.J. Court Opinions

1 NEW JERSEY DENTAL ASSOCIATION v. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY -- rank: 1000

... stand-alone dental plans of the overpayment recovery provisions in N.J.S.A. 17:48E-10.1(d)(10), (11), and N.J.S.A. 17B ... that the provider can reconcile each covered person's bill. [ N.J.S.A. 17:48E-10.1(d)(11); N.J.S.A. 17B:27-44 ... refer in a separate subsection to "the health benefits plan." N.J.S.A. 17:48E-10.1(d)(1)(c); N.J.S.A. 17B:27 ... dental plans. Horizon also argues that a related statutory provision, N.J.S.A. 17:48E-10.2(a)(1), demonstrates that dental benefits are covered by the overpayment framework in N.J.S.A. 17:48E-10.1(d)(10), (11). Subsection 10.2(a)(1) was ... person in accordance with the time frames set forth in [ N.J.S.A. 17:48E-10.1]." N.J.S.A. 17:48E-10.2( ...

docket:	a1834-12
court:	NJ Superior Court Appellate Division
decided:	2014-06-05
status:	unpublished
citation:
Document Size:	44113

2 NEW JERSEY DENTAL ASSOCIATION v. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY -- rank: 929

... assignment clauses such as that in question here. Because, however, N.J.S.A. 17:48E-10.2 more specifically deals with the subject matter and implicitly ... 2 The trial judge correctly concluded, as Horizon argued, that N.J.S.A. 17:48E-10.2 authorizes the use of the contractual provision in question ... network dentist shall issue the payment to the covered person ." N.J.S.A. 17:48E-10.2(a)(1) (emphasis added). This statute does not authorize ... ing] over" of the "payment received" by the covered person. N.J.S.A. 17:48E-10.2(b). The plain understanding of these provisions leads to ... 1-1. In seeking to avoid the plain meaning of N.J.S.A. 17:48E-10.2, plaintiff urges our consideration of more recent legislation. To ... was intended to eviscerate the reading we have attributed to N.J.S.A. 17:48E-10.2(a)(1). In other words, this appeal requires ...

docket:	a4449-10
court:	NJ Superior Court Appellate Division
decided:	2011-12-20
status:	unpublished
citation:
Document Size:	18812

3 CAPITAL HEALTH SYSTEM INC v. HORIZON HEALTHCARE SERVICES, INC -- rank: 765

... through a network of participating providers that, as authorized under N.J.S.A. 17:48E-10, have entered into "Network Hospital Agreements" (Network Agreements) with Horizon ...

docket:	a2913-15
court:	NJ Superior Court Appellate Division
decided:	2016-06-23
status:	published
citation:
Document Size:	82989

4 NEW JERSEY DENTAL ASSOCIATION v. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY -- rank: 706

... Health Claims Authorization, Processing and Payment Act (the Act), and N.J.S.A. 17:48E-10.1d (10) and (11) of the Prompt Payment Statute, apply ... claim upon which relief can be granted, the judge stated: N.J.S.A. 17:48E-10.1 and N.J.S.A. 17:48E-10.2 specifically allow for the actions taken by [defendants] in ...

docket:	a6014-10
court:	NJ Superior Court Appellate Division
decided:	2012-05-30
status:	unpublished
citation:
Document Size:	28210

5 NEW JERSEY PODIATRIC MEDICAL SOCIETY, INC v. HORIZON BLUE CROSS BLUE SHIELD OF NEW JERSEY -- rank: 629

... to the Commissioner of the Department of Banking and Insurance. N.J.S.A. 17:48E-10(a). A medical provider has the right to terminate the ... upon thirty days' written notice to the health services corporation. N.J.S.A. 17:48E-10(a)(2). As an example, the parties provided the Specialty ... addressing that issue. 3 The Department confirmed that, pursuant to N.J.S.A. 17:48E-10(e), it had jurisdiction to resolve disputes between a health ...

docket:	a1459-13
court:	NJ Superior Court Appellate Division
decided:	2014-11-17
status:	unpublished
citation:
Document Size:	31254

6 IN THE MATTER OF THE ADOPTION OF AMENDMENTS TO N.J.A.C. 11:22-1.1 -- rank: 564

... reconcile each covered person's bill. A-2828-17T2 3 [ N.J.S.A. 17:48E-10.1(d) (health service corporations); N.J.S.A. 17B ...

docket:	a2828-17
court:	NJ Superior Court Appellate Division
decided:	2019-04-29
status:	Published
citation:	459 N.J.Super. 32 207 A.3d 772
Document Size:	28618

7 SOMERSET ORTHOPEDIC ASSOCIATES, P.A. et al. v. HORIZON BLUE CROSS et al. -- rank: 453

... corporation agrees to make payment directly to the participating provider." N.J.S.A. 17:48E-10(b).     Providers who have not entered into contracts with Horizon ...

docket:	A1562-00
court:	NJ Superior Court Appellate Division
decided:	2001-12-04
status:	published
citation:	345 N.J. Super. 410 785 A.2d 457
Document Size:	37933

8 STATE OF NEW JERSEY v. WALTER TOWNSEND -- rank: 432

... health service corporation." In this manner, the Commissioner found that N.J.S.A. 17:48E-10, of the HSCA, was "applicable to the Agreement and requires ... Instead, we suggest that the Legislature may wish to review N.J.S.A. 17:48E-10(a)(2), in light of the concerns highlighted by this ...

docket:	a4898-02
court:	njappellate
decided:	2005-01-03
status:	published
citation:	374 N.J. Super. 101
Document Size:	17694