{"data":{"id":"us-nj/n.j.-stat.-52-17b-198","jurisdiction":"us-nj","citation":"N.J. Stat. § 52:17B-198","heading":"Joint negotiations regarding non-fee related matters.","body":"3.\tTwo or more independent physicians or dentists who are practicing in the service area of a carrier may jointly negotiate with a carrier and engage in related joint activity, as provided in this act, regarding non-fee-related matters which may affect patient care, including, but not limited to, any of the following:\na.\tthe definition of medical necessity and other conditions of coverage;\nb.\tutilization management criteria and procedures;\nc.\tclinical practice guidelines;\nd.\tpreventive care and other medical management policies;\ne.\tpatient referral standards and procedures, including, but not limited to, those applicable to out-of-network referrals;\nf.\tdrug formularies and standards and procedures for prescribing off-formulary drugs;\ng.\tquality assurance programs;\nh.\trespective physician or dentist and carrier liability for the treatment or lack of treatment of covered persons;\ni.\tthe methods and timing of payments;\nj.\tother administrative procedures, including, but not limited to, eligibility verification systems and claim documentation requirements for covered persons;\nk.\tcredentialing standards and procedures for the selection, retention and termination of participating physicians or dentists;\nl.\tmechanisms for resolving disputes between the carrier and physicians or dentists, including, but not limited to, the appeals process for utilization management and credentialing determinations;\nm.\tthe health benefits or dental plans sold or administered by the carrier in which the physicians or dentists are required to participate;\nn.\tthe formulation and application of reimbursement methodology;\no.\tthe terms and conditions of physician or dentist contracts, including, but not limited to, all products clauses, and the duration and renewal provisions of the contract; and\np.\tthe inclusion or alteration of a contractual term or condition, except when the inclusion or alteration is required by a federal or State regulation concerning that term or condition; however, the restriction shall not limit a physician's or dentist's rights to jointly petition the federal or State government, as applicable, to change the regulation.\nL.2001,c.371,s.3; per s.15, act expires April 8, 2008.","path":["TITLE 52 STATE GOVERNMENT, DEPARTMENTS AND OFFICERS"],"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":"bb39952f0a2d9ae2a8e0a2165eb23829823fb6717912480f190cee917d927a02","source_id":"us-nj","stale":true,"prev":"us-nj/n.j.-stat.-52-17b-197","next":"us-nj/n.j.-stat.-52-17b-199"},"notice":"GroundRules: Original legal text. Not legal advice."}