2023 New Jersey Revised Statutes › Title 52 - State Government, Departments and Officers › Section 52:14-17.30b - Contract for services of a third-party medical claims reviewer.

52:14-17.30b Contract for services of a third-party medical claims reviewer.
2. a. Notwithstanding the provisions of any other law to the contrary, a contract for the services of a third-party medical claims reviewer for the State Health Benefits Program and the School Employees' Health Benefits Program shall be procured in an expedited process and in the manner provided by this section.
b. The Division of Purchase and Property in the Department of the Treasury shall procure, without the need for formal advertisement, but through the solicitation of proposals from professional services vendors, a third-party medical claims reviewer, which shall be responsible for the strict oversight of the adjudication and processing of direct payments for health care services rendered to participants in the State Health Benefits Program and School Employees' Health Benefits Program. The third-party medical claims reviewer shall perform all duties in accordance with all applicable State and federal laws and with the rules and regulations issued by the State Treasurer and the State Health Benefits Commission and the School Employees' Health Benefits Commission, and shall act in the best interests of the State, participating employers, and covered persons under the programs. The third-party medical claims reviewer shall not be the carrier, or a subsidiary, related party, or affiliate thereof, with which the State has contracted pursuant to section 4 of P.L.1961, c.49 (C.52:14-17.28) or section 35 of P.L.2007, c.103 (C.52:14-17.46.5) for the provision of hospital, surgical, obstetrical, and other covered health care services and benefits or for the provider networks for those services. The third-party medical claims reviewer shall not exercise any authority over the provision of health care benefits for Medicare-eligible retirees. The contract awarded for the services of the third-party medical claims reviewer may include provisions permitting the compensation of the third-party medical claims reviewer based upon a percentage of the costs recovered by the State as a result of the information provided by the third-party medical claims reviewer in the performance of its duties.
c. Notwithstanding the provisions of any other law to the contrary, for the purpose of expediting the procurement of a third-party medical claims reviewer, the following provisions shall apply as modifications to law or regulation that may interfere with the expedited procurement:
(1) the timeframes for challenging the specifications shall be modified as determined by the division;
(2) in lieu of advertising in accordance with sections 2, 3, and 4 of P.L.1954, c.48 (C.52:34-7, C.52:34-8, and C.52:34-9), the division shall advertise the request for proposals for the above service and any addenda thereto on the division's website;
(3) the period of time that the State Comptroller has to review the request for proposals for the procurement of a third-party medical claims reviewer for compliance with applicable public contracting laws, rules, and regulations, pursuant to section 10 of P.L.2007, c.52 (C.52:15C-10), shall be 10 business days or less if practicable, as determined by the State Comptroller;
(4) the timeframes for submission under section 4 of P.L.2012, c.25 (C.52:32-58) and section 1 of P.L.1977, c.33 (C.52:25-24.2) shall be extended to prior to the issuance of a Notice of Intent to Award;
(5) the provisions of section 1 of P.L.2005, c.92 (C.52:34-13.2) shall not apply to technical and support services, under this section, provided by a vendor using a "24/7 follow-the-sun model" as long as the contractor is able to provide such services in the United States during the business day; and
(6) the term "bids" in subparagraph (f) of subsection a. of section 7 of P.L.1954, c.48 (C.52:34-12) shall not include pricing which will be revealed to all responsive bidders during the negotiation process.
d. The division may, to the extent necessary, waive or modify any requirement under any other law or regulation that may interfere with the expeditious procurement of this service.
e. Upon the expiration of the initial contract for a third-party medical claims reviewer procured pursuant to subsection b. of this section, the procurement of such service thereafter shall be required and in accordance with P.L.1954, c.48 (C.52:34-6 et seq.) and any other applicable law governing the awarding of public contracts by a State agency.
L.2019, c.143, s.2.