This bill revises the credentialing process for physicians seeking to join health insurance carriers' provider networks in New Jersey. Key changes include a requirement for carrier committees to notify applicants within 30 days if their application is incomplete, with the application deemed complete if no notification is received. Additionally, carriers must provide universal participation and renewal forms on their websites, along with a detailed explanation of the credentialing process and required documents. The bill also stipulates that physicians delivering healthcare services while awaiting credential approval must be reimbursed for those services from the date their application was filed.

Furthermore, the bill prohibits carriers from requiring already credentialed physicians to submit new applications solely due to a change in employers or healthcare facilities. It empowers the Department of Banking and Insurance to handle complaints regarding violations of the credentialing process, including the establishment of a system for receiving and investigating such complaints. The bill aims to enhance transparency and enforcement in the credentialing process, ensuring that healthcare professionals are treated fairly and efficiently.

Statutes affected:
Introduced: 26:2S-7, 26:2S-7.2