N.J. Admin. Code § 11:24B-2.8

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-2.8 - Annual report and renewal

(a) The certification of an ODS shall expire three years after issuance. A certification shall automatically renew for another three-year period unless the Department finds that the ODS no longer complies with the Act or other applicable law, or if the ODS fails to file a complete annual report and information set forth in this section.

(b) An ODS shall file an annual report with the Department no later than March 1 of each year for the year ended December 31 immediately preceding on the form prescribed by the Department which can be found on the Department's website: www.state.nj.us/dobi/formlist.htm. The information required shall include:

1. The total number of provider and member complaints filed within the year being reported upon, categorized by type of complaint;

2. The total number of utilization management requests for authorization and the total number of denials;

3. The total number of utilization management appeals filed and the outcome of such appeals; and

4. The total number of claims paid, the total number of claim appeals filed and processed, and the resolution of such appeals.

(c) The annual report required in (b) above shall be accompanied by a current directory of the ODS' providers.

(d) In addition to the requirements in (b) and (c) above, the Commissioner may examine the operations of an ODS or request additional information from an individual ODS as deemed necessary by the Commissioner to determine compliance with 17:48H-1 et seq. or this subchapter.

N.J. Admin. Code § 11:24B-2.8

Repeal and New Rule, R.2009 d.243, effective 8/3/2009.
See: 40 N.J.R. 6529(a), 41 N.J.R. 2965(a).
Section was "CODS: renewal of a certification".