N.J.S.A. 17B:30-55.16 — Statistics available regarding prior authorization approvals, denials, website.

17B:30-55.16 Statistics available regarding prior authorization approvals, denials, website. 17. A payer shall make statistics available regarding prior authorization approvals and denials on its Internet website in a readily accessible format, as determined by the commissioner. Payers shall include categories for: a. health care provider specialty; b. medication or diagnostic tests and procedures; c. indication offered; d. reason for denial; e. whether prior authorization determinations were: (1) appealed; or (2) approved or denied on appeal; f. the time between submission of prior authorization requests and the determination; g. the average median time elapsed between a request for clinical records from the requesting health care provider and receipt of adequate clinical records to complete the prior authorization; and h. the number of appeals generated for cases denied in which there was inadequate or no prior clinical information. L.2023, c.296, s.17.

This is the verbatim text of N.J.S.A. 17B:30-55.16, retrieved from the New Jersey Legislature's public statute corpus. Statutes are amended periodically — for the most current version, check the external source link above. Kyzer is not a law firm and this page is not legal advice.