Rutgers Law

Title: 17B - INSURANCE

Chapter: 30 - Declaration of purpose

17b:30-1: Declaration of purpose

17b:30-2: Practices prohibited

17b:30-3: Misrepresentations and false advertising of policies or annuity contracts

17b:30-4: False information and advertising

17b:30-5: False financial statements

17b:30-6: "Twisting" prohibited

17b:30-7: Defamation

17b:30-8: Boycott, coercion and intimidation

17b:30-9: Stock operations and advisory board contracts

17b:30-10: Stock acquisition, common management

17b:30-11: Interlocking directorate

17b:30-12: Discrimination prohibited; terms defined.

17b:30-13: Rebates and special inducements

17b:30-13.1: Unfair claim settlement practices

17b:30-13.2: Record of complaints

17b:30-14: Exceptions to discrimination and rebates

17b:30-15: Enumeration of acts not exclusive

17b:30-16: Commissioner's powers of investigation

17b:30-17: Desist orders for prohibited practices; penalty

17b:30-18: Procedures as to undefined practices

17b:30-19: Appeal by intervenor

17b:30-20: Violation of cease and desist order; penalty

17b:30-21: Provisions of chapter additional to existing laws

17b:30-22: Immunity from prosecution

17b:30-23: Timetable for implementation of electronic receipt, transmission of health care claim information; standard forms.

17b:30-24: Regulations.

17b:30-25: Thomas A. Edison State College to study, monitor effectiveness of electronic data interchange technology, electronic health records.

17b:30-26: Definitions relative to payment of health and dental insurance plans.

17b:30-27: Applicability.

17b:30-28: Provision of information.

17b:30-29: Provision of toll-free telephone number.

17b:30-30: Maintenance of claims records; audit required.

17b:30-31: Additional record of claims.

17b:30-32: Overdue capitation payment.

17b:30-33: Regulations.

17b:30-34: Inapplicability of act.

17b:30-34.1: Health care provider, carrier, more than one method of payment, reimbursement; definitions.

17b:30-35: Definitions relative to standardized pharmacy identification cards

17b:30-36: Issuance of standardized pharmacy identification information, card to primary insured

17b:30-37: Exceptions for issuance of card

17b:30-38: Provision of new pharmacy identification card

17b:30-39: Rules, regulations

17b:30-40: Definitions, construction, regulations on notice of premium increase to employers.

17b:30-41: Findings, declarations relative to collection of unpaid hospital accounts.

17b:30-42: Definitions relative to collection of unpaid hospital accounts.

17b:30-44: "New Jersey Hospital Care Payment Fund."

17b:30-45: Authority of department.

17b:30-46: Decisions of department constitute final agency action.

17b:30-47: Procedures for participating hospitals.

17b:30-48: Short title.

17b:30-49: Findings, declarations relative to processing health claims.

17b:30-50: Definitions relative to processing health claims.

17b:30-51: Information required from payer.

17b:30-52: Response by payer to request for authorization of health care services.

17b:30-53: Reimbursement for covered services, conditions.

17b:30-54: Reimbursement according to provider contract.

17b:30-55: Violations, penalties; rules, regulations.

17b:30-55.1: Short title.

17b:30-55.2: Findings, declarations.

17b:30-55.3: Definitions.

17b:30-55.4: Payer, information, utilization management, processing, payment of claims.

17b:30-55.5: Payer, respond, hospital, health care provider request, prior authorization.

17b:30-55.6: Carrier, respond, prior authorization requests, medication coverage submitted, NCPDP SCRIPT Standard for ePA transactions.

17b:30-55.7: Prior authorization, chronic, long-term care condition, validity, exception, timeline.

17b:30-55.8: Prior authorization, denial, limitation imposed by payer, physician, scope of actions.

17b:30-55.9: Prior authorization, defined number, discrete services, set time frame, validity, exception.

17b:30-55.10: Payer to honor prior authorization granted to covered person by previous payer, initial coverage, upon receipt of documentation.

17b:30-55.11: Denial of prior authorization, communicated via written communication agreed to by payer, hospital, health care provider.

17b:30-55.12: Adverse determinations, appeal, reviewed by physician.

17b:30-55.13: Payer shall not deny reimbursement, hospital, health care provider in compliance, circumstances,

17b:30-55.14: Payer, reimbursement according to provider contract, medically necessary emergency, urgent care covered under plan.

17b:30-55.15: Failure by payer to comply with deadline, health care services subject to review, automatic authorization.

17b:30-55.16: Statistics available regarding prior authorization approvals, denials, website.

17b:30-55.17: Liberal construction.

17b:30-56: Rules, regulations.

17b:30-57: Liberal construction.

17b:30-58: Definitions relative to reimbursement for certain ambulance services.

17b:30-59: Assignment of benefits to service provider of right to receive reimbursement for ambulance service.

17b:30-60: Definitions relative to certain dental provider networks.

17b:30-61: Third party access.

17b:30-62: Inapplicability.

17b:30-63: Rules, regulations.