Requires collection of data by health insurers regarding health insurance claims and decisions made using automated utilization management systems.
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Progress
Where this bill stands in the legislative process.
- Introduced
- Passed Senate
- Passed General Assembly
- To Governor
- Became Law
Overview
This bill requires New Jersey health insurers to collect and publicly share data on health insurance claims and decisions made using automated utilization management systems. Specifically, it mandates the reporting of claim denial rates, the number of appeals sustained and overturned, and data on frequently denied claims by medical specialty. Additionally, the bill introduces requirements for physician oversight of claims reviews, transparent disclosure of utilization management system use, and the Department of Banking and Insurance’s authority to audit these systems. Failure to justify claim denials exceeding a certain threshold may result in a refund to covered individuals.
Bill text
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Document of record
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Sponsors
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2 on record
Primary sponsors
Anthony Bucco
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