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N.J. Stat. Ann. § 17B:30-55.16

Statistics available regarding prior authorization approvals, denials, website

Known as the New Jersey Life and Health Insurance Guaranty Association Act

The act spans §§ 17B:17-1 to 17B:37-9 (1,003 sections).

L.2023, c.296, s.17.

17. 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.

Current official text: New Jersey Legislature. Digitized from the New Jersey Legislature bulk statutes download. Reproduced from public-domain New Jersey statutes; confirm against the official source for the current text. Not legal advice.