reglab/housing_qa huggingface dataset:
NJ Rev Stat § 17B:30-22 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-22 - Immunity from prosecution

17B:30-22. Immunity from prosecution  If any person shall ask to be excused from testifying or from producing any books, papers, records, correspondence or other documents at any hearing on the ground that the testimony or evidence required of him may tend to incriminate him or subject him to a penalty or forfeiture, and shall notwithstanding be directed to give such testimony or produce such evidence, he must nonetheless comply with such direction, but he shall not thereafter be prosecuted or subjected to any penalty or forfeiture for or on account of any transaction, matter or thing concerning which he may testify or produce evidence pursuant thereto, and no testimony so given or evidence produced shall be received against him upon any criminal action, investigation or proceeding; provided, however, that no such individual so testifying shall be exempt from prosecution or punishment for any perjury committed by him while so testifying and the testimony or evidence so given or produced shall be admissible against him upon any criminal action, investigation or proceeding concerning such perjury, nor shall he be exempt from the refusal, revocation or suspension of any license, permission or authority conferred, or to be conferred, pursuant to the insurance laws of this State. Any such person may execute, acknowledge and file in the office of the commissioner a statement expressly waiving such immunity or privilege in respect to any transaction, matter or thing specified in such statement and thereupon the testimony of such person or such evidence in relation to such transaction, matter or thing may be received or produced before any judge, court, tribunal, grand jury or other officer or body, and if so received or produced such person shall not be entitled to any immunity or privilege on account of any testimony or evidence he may so give or produce. L.1971, c. 144, s. 17B:30-22.
NJ Rev Stat § 17B:30-24 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-24 - Regulations.

17B:30-24 Regulations.  15. The Commissioner of Banking and Insurance, in consultation with the Commissioner of Health, shall adopt regulations to effectuate the purposes of sections 1 through 10 of this act, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.). To the extent practicable, the regulations shall include any provisions the commissioner deems appropriate that seek to reduce the amount of, or to consolidate, the paper forms sent by hospital, medical, health, and dental service corporations, and commercial insurers, health maintenance organizations, dental plan organizations, and prepaid prescription service organizations to health care providers and covered persons. L.1999, c.154, s.15; amended 2012, c.17, s.67.
NJ Rev Stat § 17B:30-25 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-25 - Thomas A. Edison State College to study, monitor effectiveness of electronic data interchange technology, electronic health records.

17B:30-25 Thomas A. Edison State College to study, monitor effectiveness of electronic data interchange technology, electronic health records.  16. Thomas A. Edison State College shall study and monitor the effectiveness of electronic data interchange technology and electronic health records in reducing administrative costs, identify means by which new electronic data interchange technology and electronic health records can be implemented to effect health care system cost savings, and determine the extent of electronic data interchange technology and electronic health records use in the State's health care system. The Departments of Health and Banking and Insurance or any other department upon request shall cooperate with and provide assistance to the college in carrying out its study pursuant to this section. The college shall report to the Legislature and the Governor from time to time on its findings and recommendations. L.1999, c.154, s.16; amended 2005, c.352, s.19; 2012, c.17, s.68.
NJ Rev Stat § 17B:30-27 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-27 - Applicability.

17B:30-27 Applicability.  2. The provisions of this act shall apply only to insured health benefits or dental plans and insured claims submitted to payers. L.1999,c.155,s.2.
NJ Rev Stat § 17B:30-28 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-28 - Provision of information.

17B:30-28 Provision of information.  3. A payer shall, at the request of a covered person, that person's agent, or an eligible health care provider, provide information as to the material required to be submitted to the payer with a claim for reimbursement, including any documentation which is to be submitted with the claim and information as to the proper coding, including the standard diagnosis and procedure codes used by the payer. L.1999,c.155,s.3.
NJ Rev Stat § 17B:30-29 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-29 - Provision of toll-free telephone number.

17B:30-29 Provision of toll-free telephone number.  4. A payer shall provide covered persons and eligible health care providers with a toll-free telephone number for making inquiries regarding paid claims or pending claims. If the commissioner determines that the toll-free telephone numbers provided by the payer are not adequate, he may require separate toll-free numbers for covered persons and health care providers.  A payer shall respond to any covered person's or health care provider's claim inquiry no later than three business days after receipt of the inquiry.  L.1999,c.155,s.4.
NJ Rev Stat § 17B:30-31 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-31 - Additional record of claims.

17B:30-31 Additional record of claims.  6. a. In addition to the annual audit required by section 5 of this act, the payer shall maintain and report to the commissioner on no less than a quarterly basis, a record of claims as provided in paragraphs (1) through (9) of subsection a. of section 5 of this act. b. After reviewing a report, the commissioner may require an immediate audit of the payer by a private audit firm and after reviewing the audit, if he deems it necessary, may proceed with a remediation or monitoring procedure as provided by subsection b. of section 5 of this act. L.1999,c.155,s.6.
NJ Rev Stat § 17B:30-32 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-32 - Overdue capitation payment.

17B:30-32 Overdue capitation payment.  7. a. Payment of a capitation payment to a health care provider shall be deemed to be overdue if not remitted to the provider on the fifth business day following the due date of the payment in the contract, if: the health care provider is not in violation of the terms of the contract; and the health care provider has supplied such information to the insurer as may be required under the contract before payment is to be made.  b. An overdue payment shall bear simple interest at the rate of 10% per annum.  L.1999,c.155,s.7.
NJ Rev Stat § 17B:30-33 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-33 - Regulations.

17B:30-33 Regulations.  8. No later than 180 days following the date of enactment of this act, the commissioner shall adopt regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.) necessary to carry out the purposes of this act. L.1999,c.155,s.8.
NJ Rev Stat § 17B:30-34 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-34 - Inapplicability of act.

17B:30-34 Inapplicability of act.  9. The provisions of this act shall not apply to any payer determined by the commissioner to be impaired, to be subject to the provisions of the "Life and Health Insurers Rehabilitation and Liquidation Act," P.L.1992, c.65 (C.17B:32-31 et seq.), or to any claims payable by the "New Jersey Life and Health Insurance Guaranty Association Act" pursuant to P.L.1991, c. 208 (C.17B:32A-1 et seq.). L.1999,c.155,s.9.
NJ Rev Stat § 17B:30-35 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-35 - Definitions relative to standardized pharmacy identification cards

17B:30-35. Definitions relative to standardized pharmacy identification cards  1. As used in this act: "Carrier" means an insurance company, health service corporation, hospital service corporation, medical service corporation or health maintenance organization authorized to issue health benefits plans in this State. "Health benefits plan" means: a health benefits plan that is delivered or issued for delivery in this State by or through a carrier; a plan provided by a multiple employer welfare arrangement; or a plan provided by another benefit arrangement, to the extent permitted by the "Employee Retirement Income Security Act of 1974," Pub.L.93-406 (29 U.S.C. s.1001 et seq.), or by any waiver of or other exception to that act provided under federal law or regulation. "Health benefits plan" shall not include accident-only insurance; credit accident and health insurance; Medicare supplement insurance; Medicaid fee-for-service; disability income insurance; long-term care insurance; specified disease insurance; dental or vision care plan; hospital indemnity insurance; coverage issued as a supplement to liability insurance; medical payments under automobile or homeowners insurance; or insurance under which benefits are payable without regard to fault and that are statutorily required to be included in a liability policy or equivalent self-insurance program. L.2001,c.200,s.1.
NJ Rev Stat § 17B:30-36 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-36 - Issuance of standardized pharmacy identification information, card to primary insured

17B:30-36. Issuance of standardized pharmacy identification information, card to primary insured  2. a. A carrier, multiple employer welfare arrangement or other health benefits plan provider, or its agents, contractors or administrators, including but not limited to a pharmacy benefits manager or third party administrator for a self-insured health benefits plan, that provides, administers or manages coverage for prescription drugs provided on an outpatient basis, shall issue or require the issuance to the primary insured of a card or other technology that includes standardized pharmacy identification information. b. The card shall comply with the standards set forth in the National Council for Prescription Drug Programs Pharmacy ID Card Implementation Guide in effect at the time of card issuance, or, at a minimum, contain the following information: (1) the name or identification number of the health benefits plan, when required for proper claims adjudication; (2) the American National Standards Institute International Identification Number assigned to the administrator or pharmacy benefits manager of the health benefits plan, labeled as RxBIN, when required for proper claims adjudication; (3) the processor control number, labeled as RxPCN, when required for proper claims adjudication; (4) the insured's group number, labeled as RxGRP, when required for proper claims adjudication; (5) the insured's identification number; (6) the insured's name; except that, if a separate card is issued for another person included under the primary insured's coverage, the name of the covered person to whom the card is issued may be listed instead of the name of the primary insured; (7) the telephone number that providers may call for pharmacy benefits assistance; and (8) any other information necessary for proper claims adjudication, except for information provided on the prescription as required by law or regulation. L.2001,c.200,s.2.
NJ Rev Stat § 17B:30-37 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-37 - Exceptions for issuance of card

17B:30-37. Exceptions for issuance of card  3. a. A carrier, multiple employer welfare arrangement or other health benefits plan provider shall not be required to issue a pharmacy identification card separate from another identification card issued to an insured under a health benefits plan if the identification card contains the information required pursuant to section 2 of this act. b. A carrier, multiple employer welfare arrangement or other health benefits plan provider may use data elements that are required by State or federal regulations adopted pursuant to the "Health Insurance Portability and Accountability Act of 1996," Pub.L.104-191, in place of the information required pursuant to section 2 of this act. L.2001,c.200,s.3.
NJ Rev Stat § 17B:30-38 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-38 - Provision of new pharmacy identification card

17B:30-38. Provision of new pharmacy identification card  4. A carrier, multiple employer welfare arrangement or other health benefits plan provider shall provide each primary insured with a new pharmacy identification card within a reasonable time, not to exceed 180 days, after a change in the insured's coverage that changes the information required to be on the card pursuant to section 2 of this act, if the issuance of a new card is required for proper claims adjudication. The carrier, multiple employer welfare arrangement or other health benefits plan provider shall not, however, be required to issue a new card more than once in a calendar year. Except as required by this section, a carrier, multiple employer welfare arrangement or other health benefits plan provider shall not be required to reissue a pharmacy identification card with any particular frequency. L.2001,c.200,s.4.
NJ Rev Stat § 17B:30-39 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-39 - Rules, regulations

17B:30-39. Rules, regulations  5. The Commissioner of Banking and Insurance shall adopt rules and regulations pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), to carry out the purposes of this act. L.2001,c.200,s.5.
NJ Rev Stat § 17B:30-40 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-40 - Definitions, construction, regulations on notice of premium increase to employers.

17B:30-40 Definitions, construction, regulations on notice of premium increase to employers.  5. a. As used in this section: "Carrier"means any entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner of Banking and Insurance, that contracts or offers to contract to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services, including an insurance company authorized to issue health insurance, a health maintenance organization, a hospital service corporation, medical service corporation and health service corporation, or any other entity providing a plan of health insurance, health benefits or health services. The term "carrier" shall not include a joint insurance fund established pursuant to State law. "Health benefits plan" means a health benefits plan as defined in section 2 of P.L.1997, c.192 (C.26:2S-2). b. For the renewal of a health benefits plan for which the premium rate will increase, a carrier shall provide, in writing, 60 days' prior notice of the amount of the increase, to the employer that purchased that plan. c. The provisions of this section shall not be construed to diminish the right of a carrier to negotiate with an employer that purchased a health benefits plan over the amount of any proposed increase in the premium rate for the renewal of that plan. d. The Commissioner of Banking and Insurance shall promulgate regulations, pursuant to the "Administrative Procedure Act," P.L.1968, c.410 (C.52:14B-1 et seq.), necessary to effectuate the provisions of this section. L.2003,c.27,s.5.
NJ Rev Stat § 17B:30-41 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-41 - Findings, declarations relative to collection of unpaid hospital accounts.

17B:30-41 Findings, declarations relative to collection of unpaid hospital accounts.  1. The Legislature finds and declares that: a. The rising cost of hospital-based health care in this State impedes the ability of the State and insurers to provide reasonably priced, comprehensive health insurance to the citizens of the State. b. Hospitals located within the State report more than $1 billion annually in debts that they are unable to collect. c. The cost of covering the unpaid care represented by the debt is spread among citizens, private insurers, hospitals and the State in the form of higher bills for hospital-based care. d. A significant portion of the uncollected debt is related to copayments and deductibles that are difficult for hospitals to collect efficiently. e. The State's Set off of Individual Liability (SOIL) program has proven to be an administratively efficient means of collecting debts owed to State agencies. f. It is, therefore, in the public interest to create a system for using the State's SOIL program to collect valid hospital debts. L.2003, c.112, s.1; amended 2010, c.87, s.4.
NJ Rev Stat § 17B:30-42 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-42 - Definitions relative to collection of unpaid hospital accounts.

17B:30-42 Definitions relative to collection of unpaid hospital accounts.  2. As used in this act: "Coinsurance" means the percentage of a charge covered by a health plan that must be paid by a person covered under the health plan. "Collection agency" means the Department of the Treasury and any company, agency, or law firm engaged in collecting debts that the Department of the Treasury may determine to engage to assist it in collecting debts. "Debt" means money owed by a patient to a hospital, or by someone who is legally responsible for payment for a patient, and includes late payment penalties and interest thereon. It does not include monies owed to a hospital by a health plan for services provided by the hospital to a person with coverage under that plan, or amounts subject to dispute between a health plan and a hospital. "Debtor" means an individual owing money to or having a delinquent account with a hospital, which obligation has not been adjudicated, satisfied by court order, set aside by court order, or discharged in bankruptcy. "Deductible" means the amount of covered charges under a health plan that an individual must pay for services before a health plan begins to pay on a covered charge. "Department" means the Department of Health. "General Hospital" and "hospital" have the meanings set forth in N.J.A.C.8:43G-1.2. "Health plan" means an individual or group health benefits plan that provides or pays the cost of hospital and medical expenses, dental or vision care, or prescription drugs, and is provided by or through an insurer, health maintenance organization, the Medicaid program, the Medicare program, a Medicare+Choice provider or Medicare supplemental insurer, an employer-sponsored group health benefits plan, government or church-sponsored health benefits plan or a multi-employer welfare arrangement. "Medicaid" means the program established pursuant to P.L.1968, c.413 (C.30:4D-1 et seq.). "Medicare" means the program established by Pub.L.89-97 (42 U.S.C. s.1395 et seq.) as amended, or its successor plan or plans. "Patient" means a person who receives services in a hospital on an inpatient or outpatient basis. L.2003, c.112, s.2; amended 2010, c.87, s.5; 2012, c.17, s.69.
NJ Rev Stat § 17B:30-44 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-44 - "New Jersey Hospital Care Payment Fund."

17B:30-44 "New Jersey Hospital Care Payment Fund."  4. a. There is established the "New Jersey Hospital Care Payment Fund" in the Department of the Treasury. b. The fund shall be comprised of monies collected from debtors of hospitals pursuant to this act, and any other monies appropriated thereto to carry out the purposes of this act. c. The fund shall be a nonlapsing fund, from which costs shall be paid in the following order, for each hospital participating: (1) administrative costs of the department to implement the provisions of P.L.2003, c.112 (C.17B:30-41 et seq.); (2) administrative fees to the collection agency; (3) 50% of the remainder, but only from monies collected from debtors of hospitals pursuant to this act after paragraphs (1) and (2) of this subsection are paid, shall be payable to the hospital from which the debt originated within 90 days of receipt of monies related to discharge of the assigned debt into the fund; and (4) the remainder, after paragraphs (1), (2) and (3) of this subsection are paid, shall be deposited into the General Fund. L.2003, c.112, s.4; amended 2010, c.87, s.6.
NJ Rev Stat § 17B:30-46 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-46 - Decisions of department constitute final agency action.

17B:30-46 Decisions of department constitute final agency action.  6. Decisions of the department, regarding the fairness formula, the validity of debts, the adequacy of data provided to the department by hospitals for use in the program, and other such matters as shall arise concerning the administration of the program, shall constitute final agency action. L.2003, c.112, s.6; amended 2010, c.87, s.8.
NJ Rev Stat § 17B:30-48 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-48 - Short title.

17B:30-48 Short title.  1. This act shall be known and may be cited as the "Health Claims Authorization, Processing and Payment Act." L.2005,c.352,s.1.
NJ Rev Stat § 17B:30-49 (2021)
2021 New Jersey Revised Statutes|Title 17B - Insurance|Section 17B:30-49 - Findings, declarations relative to processing health claims.

17B:30-49 Findings, declarations relative to processing health claims.  2. The Legislature finds and declares that: a. Health care services available under health benefits plans must be promptly provided to covered persons under all circumstances, along with timely reimbursement to hospitals and physicians for their services rendered; b. However, confusion still exists among consumers, hospitals, physicians and carriers with respect to time frames for communication of determinations by carriers to deny, reduce or terminate benefits under the provisions of a health benefits plan based upon utilization management decisions; c. Since it is the declared public policy of the State that hospital and related health care services be of the highest quality and demonstrated need and be efficiently provided and properly utilized at a reasonable cost, the hospital care and related health care services must be appropriate to the condition of the patient and payment must be for services that were rendered to the patient; d. Because it is fair and reasonable for hospitals and physicians to receive reimbursement for health care services delivered to covered persons under their health benefits plans and inefficiencies in any area of the health care delivery system reflect poorly on all aspects of the health care delivery system, and because those inefficiencies can harm the consumers of health care, it is appropriate for the Legislature now to establish uniform procedures and guidelines for hospitals, physicians and health insurance carriers to follow in communicating and following utilization management decisions and determinations on behalf of consumers. L.2005,c.352,s.2.