Sponsored by:
Assemblywoman SHANIQUE SPEIGHT
District 29 (Essex and Hudson)
SYNOPSIS
Requires automatic issuance of credential to provide services in carrier provider network for physicians in good standing in New Jersey.
CURRENT VERSION OF TEXT
As introduced.
An Act concerning physicians in carriers’ provider networks and amending P.L.2001, c.88.
Be It Enacted by the Senate and General Assembly of the State of New Jersey:
1. Section 2 of P.L.2001, c.88 (C.26:2S-7.2) is amended to read as follows:
2. [Within 180 days of the adoption of the forms by regulation pursuant to this act, a] A carrier which offers a managed care plan shall accept the universal physician application for participation form and renewal form adopted pursuant to [this act] P.L.2001, c.88 (C.26:2S-7.1 et seq.) for the purpose of credentialing physicians who seek to participate in the carrier's provider network and for the purpose of credentialing physicians who are employed by hospitals or other health care facilities which seek to participate in the carrier's provider network. An application received for the purposes of credentialing a physician pursuant to this section, or to renew a credential, shall be deemed approved if the information included as part of the application demonstrates the license of the physician as issued by the State Board of Medical Examiners is in good standing.
Nothing in this section shall be construed to prevent a carrier from requesting additional information from an applicant that is not provided for in the universal application or renewal form, as applicable, if the requested information does not duplicate any information included in the applicable form.
(cf: P.L.2001, c.88, s.2)
2. This act shall take effect immediately and shall be applicable to applications for credentialing received on or after the effective date.
STATEMENT
This bill requires approval of an application submitted for credentialing so a physician can participate in a carrier’s provider network if the application demonstrates that the license of the physician issued by the State Board of Medical Examiners in New Jersey is in good standing. This also includes applications for the renewal of a credential. This is intended to streamline the credentialing process for physicians licensed in the State.