17:48G-1 Definitions relative to dental decision regulation.
1. As used in this act:
“Adverse dental decision” means a dental decision by an insurer or a third party administrator, or any other person acting on its behalf to deny, reduce, or fail to provide payment, in whole or in part, for a covered service based upon a dental decision.
“Board” means the New Jersey State Board of Dentistry.
“Dental decision” means a decision which is based upon a dental diagnosis or a dental judgment related to dental services performed or to be performed in the State of New Jersey, including, but not limited to, any decision relating to: the quality or appropriateness of dental services rendered or proposed to be rendered by a dentist; reasonable necessity for or customary performance of a dental service; or diagnosis or prognosis of a dental condition.
“Insurer” means an insurance company, health service corporation, hospital service corporation, medical service corporation, dental service corporation, dental plan organization or health maintenance organization authorized to issue dental contracts or plans in this State.
“Third party administrator” means “third party administrator” as defined by section 1 of Phamplet Law 2001, Chapter 267 (C. 17B:27B-1).
L.2007, C. 259, S.1.
Original Text maintained by the State of New Jersey:
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