This bill revises the credentialing process for physicians seeking to join health insurance carriers' provider networks in New Jersey. It mandates that a carrier's committee must notify applicants within 30 days if their application is incomplete, and if no notification is given, the application will be considered complete. Additionally, carriers are required to publish the universal participation and renewal forms on their websites, along with an explanation of the credentialing process and necessary documentation. The bill also stipulates that physicians delivering healthcare services while awaiting credential approval must be reimbursed for their services from the date the application was filed, provided the application is ultimately approved.

Furthermore, the bill prohibits carriers from requiring already credentialed physicians to submit new applications solely due to a change in their employer or healthcare facility. It empowers the Department of Banking and Insurance to handle complaints regarding violations of the credentialing process, including investigating alleged noncompliance and enforcing penalties against carriers that violate the established laws. This comprehensive approach aims to enhance transparency and efficiency in the credentialing process for healthcare professionals in New Jersey.

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