N.J. Stat. § 17B:30-55.16

Current through L. 2024, c. 80.

Section 17B:30-55.16 - [Effective 1/1/2025] Statistics available regarding prior authorization approvals, denials, website

A payer shall make statistics available regarding prior authorization approvals and denials on its Internet website in a readily accessible format, as determined by the commissioner. Payers shall include categories for:

a. health care provider specialty;

b. medication or diagnostic tests and procedures;

c. indication offered;

d. reason for denial;

e. whether prior authorization determinations were:

(1) appealed; or

(2) approved or denied on appeal;

f. the time between submission of prior authorization requests and the determination;

g. the average median time elapsed between a request for clinical records from the requesting health care provider and receipt of adequate clinical records to complete the prior authorization; and

h. the number of appeals generated for cases denied in which there was inadequate or no prior clinical information.

N.J.S. § 17B:30-55.16

Added by L. 2023 , c. 296, s. 17, eff. 1/1/2025.