Title 17B, Title 17B: INSURANCE

17B:27B-13 Annual reports. 13. A third party administrator shall file an annual report for the preceding calendar year with the commissioner on or before March 1 of each year, in a form and manner prescribed by the commissioner. The annual report shall contain the complete names …

17B:27B-14 Suspension, revocation of license, registration. 14. The commissioner may suspend or revoke a license or registration issued pursuant to this act if he finds that the third party administrator: a. is in an unsound financial condition; b. is using methods or practices i…

17B:27B-15 Immediate suspension of license, registration, grounds. 15. The commissioner may, without advance notice or hearing, immediately suspend the license or registration of a third party administrator if he finds that one or more of the following circumstances exist: a. the…

17B:27B-16 Certification required for third party billing services. 16. On or after January 1, 2002, no person shall act as, offer to act as or hold himself out to be a third party billing service in this State unless certified by the commissioner in accordance with this act. App…

17B:27B-17 Additional information to be filed by third party billing services. 17. In addition to the information otherwise required by this act or by the commissioner, a third party billing service shall file with the commissioner: a. a description of the applicant's proposed me…

17B:27B-18 Approval of applications for certification. 18. The commissioner may approve an application for certification as a third party billing service if he finds that the applicant meets the standards established by this act, including, but not limited to, the following: a. a…

17B:27B-19 Denial of applications for certification. 19. The commissioner may deny an application for certification as a third party billing service if he finds that any of the standards established by this act have not been met or for any other reasonable grounds. If the applica…

17B:27B-2 Licensure, registration required for third party administrators. 2. a. On or after January 1, 2002, no person shall act as, offer to act as, or hold himself out to be, a third party administrator in this State unless licensed or registered by the commissioner in accorda…

17B:27B-20 Written agreements required for conducting business as third party billing service. 20. A third party billing service shall not conduct any business with a client in the absence of a written agreement between the billing service and the client. The agreement shall be r…

17B:27B-21 Fiduciary responsibility of third party billing services. 21. A third party billing service that accepts monies from health benefits payers on behalf of a client shall be deemed to act in a fiduciary capacity on behalf of the client in the receipt and transmittal of fu…

17B:27B-22 Notification of material changes to commissioner. 22. a. A third party billing service shall immediately notify the commissioner of any material change in its ownership, control, or other fact or circumstance affecting its qualification for certification. b. A third pa…

17B:27B-23 Suspension, revocation of certification. 23. The commissioner may suspend or revoke a certification issued pursuant to this act if he finds that the third party billing service: a. is using methods or practices in the conduct of its business that render its further tra…

17B:27B-24 Violations, penalties. 24. The commissioner may, upon notice and hearing, assess a civil administrative penalty in an amount not less than $250 nor more than $5,000 for each day that a third party administrator or third party billing service is in violation of this act…

17B:27B-25 Rules, regulations. 25. The commissioner 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.267,s.25.

17B:27B-3 Additional information required for licensure, registration. 3. In addition to the information required by section 2 of this act, the applicant for licensure or registration shall file with the commissioner: a. a description of the applicant's proposed method of marketi…

17B:27B-4 Issuance of license, approval of application for registration. 4. The commissioner may issue a license to an applicant or approve an application for registration as a third party administrator if he finds that the applicant meets the standards established by this act, i…

17B:27B-5 Denial of license, registration. 5. The commissioner may deny an application for licensure or registration as a third party administrator if he finds that any of the standards established by this act have not been met or for any other reasonable grounds. If the applicat…

17B:27B-6 Provisions of written agreement; requirements. 6. A third party administrator shall not conduct any business with a benefits payer in the absence of a written agreement between the administrator and the benefits payer, except that this shall not apply to a third party a…

17B:27B-7 Access to books, records. 7. a. The commissioner shall have access to all books and records of a third party administrator for the purposes of examination, audit and inspection. Any trade secrets, proprietary information or the identity and addresses of enrollees contai…

17B:27B-8 Payment to third party administrators not based solely on claims denials. 8. If a third party administrator adjudicates claims under a health benefits plan, the commissions, fees or charges that the benefits payer pays the administrator, shall not be based solely on the…

17B:27B-9 Fiduciary responsibility of third party administrators. 9. a. A third party administrator shall be deemed to act in a fiduciary capacity on behalf of the benefits payer in the receipt and transmittal of the benefits payer's funds, and shall have all responsibility atten…