Bill Seeks to Change the Prior Authorization Process

BACK TO INSIGHTS Articles

The Ensuring Transparency in Prior Authorization Act was reported out of the Assembly Health Committee of the New Jersey State Legislature on May 26, 2022. If enacted, the bill places the onus on insurance carriers and utilization review entities acting on behalf of such carriers to make certain disclosures including statistics concerning approvals and denials, comply with deadlines to render a prior authorization or adverse determination, and notify the policyholder and the subscriber’s health care provider of same within one calendar day, or within 24 hours if it concerns an urgent health care service. If a utilization review entity fails to comply with a deadline or other requirement under the bill, then any health care services subject to review will be automatically authorized.

Click here to read the entire September 2022 Healthcare Law Update

Related Practices: Healthcare Law