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17:48G-3 Dental decisions made by third party administrator.
New Jersey Statutes (Unannotated) / NEW JERSEY GENERAL AND PERMANENT STATUTES (UPDATED THROUGH P.L.2023, c.256, and J.R.18) / TITLE 17 CORPORATIONS AND INSTITUTIONS FOR FINANCE AND INSURANCE
...
17
:
48G-3
Dental
decisions
made
by
third
party
administrator
.
17
:
48G-3
Dental
decisions
made
by
third
party
administrator
. 3. a. A
third
party
administrator
may make
dental
decisions
in connection with the processing or payment of
dental
claims or otherwise in the course of its
dental
benefit administration activity.
Dental
decisions
made
by a
third
party
administrator
shall be consistent with all of the following: (1) an initial adverse
dental
decision shall be
made
by a dentist duly licensed in this or another state; (2) if a treating dentist questions the adverse
dental
decision and specifies in writing the basis of the disagreement with the adverse
dental
decision, the
third
party
administrator
within 30 days shall: (a) designate a reviewing dentist who is duly licensed in this State or who has been issued a limited registration certificate...
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