A 5046 New Jersey General Assembly · 2024-2025 Regular Session

Revises credentialing process for physicians attempting to enter a health insurance carrier's provider network.

This bill revises New Jersey's process for health insurance carriers to credential physicians seeking to join their provider networks. It requires carriers to notify applicants within 30 days if an application is incomplete (or deem it complete if no notice is given) and to review complete applications within 30 days. The bill mandates carriers to use a standardized universal application form, post clear process details online - including required documents and timelines - and reimburse physicians for services provided during the credentialing wait period if approved. It also prohibits carriers from requiring physicians to resubmit applications solely due to changing employers within the state, and gives the Department of Banking and Insurance authority to enforce these rules and handle complaints.
Bill status in committee 1 of 4 stages cleared
Introduction
Nov 2024
Committee Review
Floor Vote
Governor
Introduced Nov 14, 2024 Last action Nov 14, 2024