N.J. Admin. Code § 11:24B-4.9

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

Section 11:24B-4.9 - Continuous quality improvement program

(a) The contract shall contain provisions that assure the ODS' ability to demonstrate compliance with 11:24B-3.3(h) and (i), except that, if the ODS is agreeing to perform continuous quality improvement only with respect to health benefits plans that are not managed care plans, the contract may contain provisions that demonstrate compliance with 11:24A-3.8.

(b) The contract shall specify the composition of committees that will address continuous quality improvement activities.

(c) The contract shall specify how the ODS' continuous quality improvement program will coordinate with complaint, appeal and credentialing programs of the carrier.

(d) The contract shall specify when and how information will be transferred between the ODS and the carrier.

N.J. Admin. Code § 11:24B-4.9