New Jersey Administrative Code › Title 11 - INSURANCE › Chapter 23 - THIRD-PARTY ADMINISTRATORS › Subchapter 5 - THIRD-PARTY BILLING SERVICES › Section 11:23-5.2 - Application filing requirements

Current through Register Vol. 56, No. 14, July 15, 2024
(a) Application for certification shall be made to the Commissioner on a form provided by the Commissioner that can be found on the Department's website at
www.state.nj.us/dobi/division_insurance/managedcare/tpapage.htm
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(b) The following information shall accompany the application:
1. A copy of the applicant's basic organizational documents, which shall include the trust agreement or other documents governing the operation of the applicant that are applicable to the applicant's form of business organization;
2. A copy of the executed bylaws, rules and regulations, or other documents relating to the operation of the applicant's internal affairs;
3. The names, addresses and official positions of the persons responsible for conducting the affairs of the applicant, including, but not limited to, if applicable: the members of the board of directors, executive committee or other governing board or committee, the principal officers or partners, shareholders owning or having the right to acquire 10 percent or more of the voting securities of the corporation or a 10 percent or more partnership interest of a partnership or equity interest, in the case of another form of business organization;
4. If the applicant accepts monies from benefits payers on behalf of clients, the application shall include a copy of the applicant's most recent financial statement audited by an independent certified public accountant;
5. A copy of the applicant's business plan, including information on staffing levels and the activities undertaken or to be undertaken in this State. The plan shall include a statement of the third party billing service's capability for providing a sufficient number of experienced and qualified personnel in the areas of claims processing and recordkeeping;
6. A list of the applicant's clients and a copy of the standard contract or contracts used by the applicant in the course of business;
7. If the applicant is not domiciled in this State and accepts monies from benefits payers on behalf of clients, the application shall be accompanied by a power of attorney, duly executed by the applicant, appointing the Commissioner and his or her successors in office as the true and lawful attorney of the applicant in and for this State for the purpose of accepting service of all lawful process in any legal action or proceeding against the organization on a cause of action arising in this State; and
8. A statement of any criminal convictions or civil, enforcement or regulatory actions, including actions relating to professional licenses, taken or pending against the applicant or any of the persons who are responsible for conducting the affairs of the applicant or the applicant's affiliates, and the resolution of those actions and proceedings, including judgments of convictions and judgments in civil actions. If a license, certificate or other authority to operate has been refused, suspended or revoked by any jurisdiction, the applicant shall provide a copy of any orders, proceedings, or determinations relating thereto.