State Codes and Statutes
Statutes > New-jersey > Title-52 > Section-52-17b > 52-17b-19852:17B-198 Joint negotiations regarding non-fee related matters.
3.Two or more independent physicians or dentists who are practicing in the service area of a carrier may jointly negotiate with a carrier and engage in related joint activity, as provided in this act, regarding non-fee-related matters which may affect patient care, including, but not limited to, any of the following:
a.the definition of medical necessity and other conditions of coverage;
b.utilization management criteria and procedures;
c.clinical practice guidelines;
d.preventive care and other medical management policies;
e.patient referral standards and procedures, including, but not limited to, those applicable to out-of-network referrals;
f.drug formularies and standards and procedures for prescribing off-formulary drugs;
g.quality assurance programs;
h.respective physician or dentist and carrier liability for the treatment or lack of treatment of covered persons;
i.the methods and timing of payments;
j.other administrative procedures, including, but not limited to, eligibility verification systems and claim documentation requirements for covered persons;
k.credentialing standards and procedures for the selection, retention and termination of participating physicians or dentists;
l.mechanisms for resolving disputes between the carrier and physicians or dentists, including, but not limited to, the appeals process for utilization management and credentialing determinations;
m.the health benefits or dental plans sold or administered by the carrier in which the physicians or dentists are required to participate;
n.the formulation and application of reimbursement methodology;
o.the terms and conditions of physician or dentist contracts, including, but not limited to, all products clauses, and the duration and renewal provisions of the contract; and
p.the inclusion or alteration of a contractual term or condition, except when the inclusion or alteration is required by a federal or State regulation concerning that term or condition; however, the restriction shall not limit a physician's or dentist's rights to jointly petition the federal or State government, as applicable, to change the regulation.
L.2001,c.371,s.3; per s.15, act expires April 8, 2008.
