An Act concerning certain application forms for dental plans 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:
C.26:2S-30 Definitions regarding dental plan application forms.
1. As used in this act:
“Carrier” means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization, or health maintenance organization, authorized to issue or act as an administrator of dental plans in this State.
“Dental plan” means a benefits plan which pays or provides dental expense benefits for covered services and is delivered or issued for delivery in this State by or through a carrier either on a stand-alone basis or as part of other coverage including, but not limited to, health benefits coverage.
C.26:2S-31 Adoption of dental plan application forms.
2. a. The Commissioner of Banking and Insurance shall adopt by regulation a universal dentist application for participation form for use by carriers which offer or administer dental plans for the purpose of credentialing dentists who seek to participate in a carrier's provider network and for the purpose of credentialing dentists who are employed by hospitals or other health care facilities which seek to participate in a carrier's provider network.
b. The commissioner shall also adopt by regulation a form for renewal of credentialing, which shall be an abbreviated version of the universal application form. The renewal form shall be designed to enable a dentist to indicate changes in the information provided in the application form.
c. The commissioner shall revise the universal application and renewal forms, as necessary, to conform to industry-wide, national standards for credentialing.
d. In developing the forms, the commissioner shall consult with the Commissioner of Human Services to ensure that the credentialing requirements for participation in the Medicaid program, established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.), and the NJ FamilyCare Program established pursuant to P.L.2005, c.156 (C.30:4J-8 et al.) are adequately reflected on the application and renewal forms.
C.26:2S-32 Acceptance of universal dentist application.
3. a. Within 180 days of the adoption of the forms by regulation pursuant to this act, a carrier which offers or administers a dental plan shall accept the universal dentist application for participation form and renewal form adopted pursuant to this act for the purpose of credentialing dentists who seek to participate in the carrier's provider network and for the purpose of credentialing dentists who are employed by hospitals or other health care facilities which seek to participate in the carrier's provider network.
b. Nothing in this section shall be construed to prevent a carrier from requesting additional information from an applicant that is not provided for in the universal application or renewal form, as applicable, if the requested information does not duplicate any information included in the applicable form.
C.26:2S-33 Adoption of regulations.
4. The Commissioner of Banking and Insurance shall adopt regulations within 180 days of the date of enactment of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to carry out the purposes of this act.
5. This act shall take effect immediately.
Approved January 31, 2019.