17:48G-4 Inapplicability of act relative to certain decisions of insurers, third party administrators.
7. This act shall not be construed:
a. To regulate insurers’ or third party administrators’ making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;
b. To regulate insurers’ or third party administrators’ use of a protocol for denying or limiting benefit payments for dental services where the protocol:
(1) has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and
(2) does not involve evaluation of an individual patient’s dental care or condition; or
C. To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviewS.
L.2007, C. 259, S.7.
Original Text maintained by the State of New Jersey:
Disclaimer: Always check for the most up to date language of a statute. Every time a new law is enacted it has a possibility of changing the wording of a statute or override case law. These pages were created to assist in looking up and migrating between statutes easily. No accuracy is guaranteed. If you need help with researching law, contact an attorney.