Joint Provider Negotiation Rules, Quarterly Reports

State of New Jersey DEPARTMENT OF BANKING AND INSURANCE OFFICE OF THE COMMISSIONER PO BOX 325 TRENTON, NJ 08625-0325 Tel (609) 292-5360 ___________________________________________________________________________________________ Visit us on the Web at www.njdobi.org New Jersey is an Equal Opportunity Employer • Printed on Recycled Paper and Recyclable JAMES E. MCGREEVEY Governor HOLLY C. BAKKE Commissioner BULLETIN NO. 04-14 TO: ALL INSURANCE COMPANIES, HEALTH SERVICE CORPORATIONS, HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE CORPORATIONS, AND HEALTH MAINTENANCE ORGANIZATIONS AUTHORIZED TO ISSUE HEALTH BENEFITS PLANS IN NEW JERSEY; ALL DENTAL SERVICE CORPORATIONS AND DENTAL PLAN ORGANIZATIONS AUTHORIZED TO ISSUE DENTAL PLANS IN NEW JERSEY FROM: HOLLY C. BAKKE, COMMISSIONER RE: JOINT PROVIDER NEGOTATION RULES, QUARTERLY REPORTS P.L. 2001, c. 371 (codified at N.J.S.A. 52:17B-196 et seq.) (the Act), enacted on January 8, 2002, and effective 90 days thereafter, authorizes independent physicians and dentists licensed in this State to jointly negotiate and enter into contractual arrangements with carriers on non-fee related matters that may affect patient care, fees, and fee-related matters. On August 2, 2004, the Department of Banking and Insurance (Department) adopted rules at N.J.A.C. 11:22-7 implementing the Act (see 36 N.J.R. 3553(a)). The rules establish standards and procedures for carriers to report to the Department certain information required by the Act. Among other things, the Department's rules at N.J.A.C. 11:22-7.3(a) require carriers to submit to the Department quarterly reports of the number of covered persons enrolled in health benefits or dental plans during that quarter. The due dates for the reports are May 15 for the first quarter, August 15 for the second quarter, November 15 for the third quarter, and March 1 for the fourth quarter. The purpose of this Bulletin is to advise carriers required to submit quarterly reports to the Department pursuant to N.J.A.C. 11:22-7.3(a) that the first report will be due March 1, 2005, and shall include data for the fourth 2 quarter 2004. Subsequent reports shall be submitted on the due dates set forth in the rules. All reports are to be completed pursuant to the format and instructions set forth in the rules. Questions regarding this Bulletin should be addressed to: Avnee Parekh Office of Life and Health NJ Department of Banking and Insurance PO Box 325 Trenton, NJ 08625-0325 Phone: 609-292-5427 x50339 Fax: 609-633-0527 Email: aparekh@dobi.state.nj.us 8/16/04 /s/ Holly C. Bakke Date Holly C. Bakke, Commissioner inoord/bb11227