Bill
A 5046
Standardizes universal physician credentialing forms and 30-day review timelines to speed insurer-network enrollment, with DOBI enforcement and patient-care continuity.
Note on title vs. content: The bill’s title references aggravated sexual abuse in the fourth degree and a private right of action for fertility fraud, with changes to statutes of limitations. The introduced text, however, primarily addresses credentialing of physicians for carrier provider networks and related enforcement. This summary focuses on the introduced provisions as written.
1) Credentialing committee timelines and completeness notice
- Carrier credentialing committees must review applications with appropriate health care professional representation.
- If reviewing a universal physician application, the committee must notify the applicant within 30 days whether the application is incomplete, specifying missing information in writing.
- If no notice is given within 30 days, the application is deemed complete.
- A complete application must be reviewed within 30 days of receipt of the completed package.
2) Universal forms and online information
- Carriers offering managed care plans must accept universal physician participation and renewal forms adopted under the act for credentialing.
- Carriers must post the universal forms, the credentialing process explanation, required documents, and timelines on their websites.
- Carriers may request additional information beyond the universal forms if not duplicative of the form’s content.
3) Reimbursement while credentialing is pending
- If a physician delivers care to network-covered patients while awaiting credentialing, the carrier must reimburse those services as of the date the credentialing application was filed, provided the application is approved.
4) Continuity for already-credentialed physicians changing employers
- A physician who is already credentialed and changes employers within New Jersey cannot be required to submit a new credentialing application solely due to the change in employer or facility.
5) Complaints, enforcement, and reporting
- Health care professionals may report suspected violations of credentialing provisions to the DOBI.
- DOBI would investigate and enforce, including creating a system to receive complaints and addressing noncompliance in a timely manner.
- Complaints must be filed within two years of when the complainant knew or should have known of the violation.
- DOBI holds sole and exclusive enforcement authority; no private right of action for credentialing violations is created.
6) Effective date
- The act would take effect on the 180th day after enactment.
Sponsors include multiple lawmakers, with Jonathan Jacobson listed as primary sponsor. Related companion and prior-session bills exist (S 3799; A 8562, A 718, A 1114).
Compiled from official sources — confirm details with the bill’s official record.
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