STATE OF NEW JERSEY
218th LEGISLATURE
PRE-FILED FOR INTRODUCTION IN THE 2018 SESSION
Sponsored by:
Assemblywoman SHAVONDA E. SUMTER
District 35 (Bergen and Passaic)
SYNOPSIS
Requires biannual audit of managed care plan provider networks.
CURRENT VERSION OF TEXT
Introduced Pending Technical Review by Legislative Counsel.
An Act concerning managed care plan provider networks and supplementing P.L.1997, c.192 (C.26:2S-1 et seq.).
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. a. A carrier which offers a managed care plan shall, at least biannually, provide for an audit by an independent private auditing firm of the carrier’s provider network for each plan that it offers. The purpose of the audit shall be to ensure that the health care providers listed as participating providers in the carrier’s provider directory are accurately listed and that they participate in the carrier’s network.
b. The carrier shall use the results of the audit to correct any inaccurate listing of a provider as a participating provider in the provider directory if the provider is, in fact, not participating.
c. The audit shall be conducted at the expense of the carrier and the carrier shall submit the audit findings to the commissioner together with a description of all efforts made by the carrier to ensure that providers listed as participating providers in the carrier’s provider directory are actually participating in the carrier’s network.
2. This act shall take effect on the 90th day next following enactment.
STATEMENT
This bill supplements the “Health Care Quality Act,” P.L.1997, c.92 (C.26:2S-1 et seq.), by requiring carriers that offer managed care health benefits plans to provide, at least biannually, for an audit by an independent private auditing firm of the carrier’s provider network for each plan that it offers. The purpose of the audit shall be to ensure that the health care providers listed as participating providers in the carrier’s provider directory are accurately listed and that they participate in the carrier’s network.
The carrier shall use the results of the audit to correct any inaccurate listing of a provider as a participating provider in the provider directory if the provider is, in fact, not participating.
The bill also provides that the audit shall be conducted at the expense of the carrier and the carrier shall submit the audit findings to the Commissioner of Banking and Insurance together with a description of all efforts made by the carrier to ensure that providers listed as participating providers in the carrier’s provider directory are participating in the carrier’s network.