{"data":{"id":"us-nj/n.j.-stat.-17b-30-55.8","jurisdiction":"us-nj","citation":"N.J. Stat. § 17B:30-55.8","heading":"Prior authorization, denial, limitation imposed by payer, physician, scope of actions.","body":"9.\tAny denial of a request for prior authorization or limitation imposed by a payer on a requested service on the basis of utilization management determination shall be made by a physician who shall:\na.\tmake the adverse determination under the clinical direction of a medical director of the payer who shall:\n(1)\tbe licensed in this State; and\n(2)\tstrictly follow a medical policy that has been developed and made available in accordance with P.L.2023, c.296 (C.17B:30-55.1 et al.) and the \"New Jersey Health Care Quality Act,\" P.L.1997, c.192 (C.26:2S-1 et seq.);\nb.\tnot be compensated by a payer based on the approval or denial rate of the reviewing physician; and\nc.\tnot be provided preferential treatment by a payer in the requests for prior authorization of the reviewing physician if that physician is also a network provider for the payer.\nL.2023, c.296, s.9.","path":["TITLE 17B INSURANCE"],"source_url":"https://pub.njleg.state.nj.us/statutes/STATUTES-TEXT.zip","current_through":"P.L.2025, c.405, and J.R.22","vintage":"","retrieved_at":"2026-08-27T17:54:13Z","sha256":"bd52cd3dbbb7b08cb342b69028fa9f9462330f8b504ffab7cda6204efb4b324d","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-17b-30-55.7","next":"us-nj/n.j.-stat.-17b-30-55.9"},"notice":"GroundRules: Original legal text. Not legal advice."}