New Jersey § 26:2s-9

§ 26:2s-9.

a. A carrier which offers a managed care plan that negotiates with a health care provider

to become a participating provider, who is reimbursed per procedure under the plan,

shall, upon request, furnish the health care provider with a written fee schedule,

or in an electronic format if agreed upon by both parties, showing the fees for the

20 most common evaluation and management codes and the 20 most common office-based

or hospital-based in-network services for the health care provider's specialty or

sub-specialty, to be provided by the health care provider under the plan pursuant

to the proposed or existing contract between the carrier and health care provider. If the carrier negotiates with the health care provider to become a participating

provider under more than one managed care plan offered by the carrier, the carrier

shall provide the applicable fee schedule for each plan. If the carrier negotiates a fee schedule with the health care provider that is specific

to that health care provider, the carrier shall provide only the applicable fee schedule

for that health care provider. If the rate that the health care provider will be paid is a percentage of another

rate, it shall be sufficient for the carrier to provide that formula to the health

care provider. The carrier shall furnish the fee schedule pursuant to this subsection within 15

days of the request of the provider. The fee schedule provided to the health care provider by the carrier is proprietary

and shall be confidential. Unauthorized distribution of the fee schedule may result in the health care provider's

termination from the network in accordance with the provisions of N.J.A.C. 8:38-1.1 et seq. b. The carrier shall reimburse the health care provider in accordance with the fee

schedule provided to the health care provider pursuant to the contract. The carrier may revise the fee schedule upon providing the health care provider

with written notice of the change and, upon request, a copy of the revised fee schedule. c. Nothing in this section shall be construed to limit the ability of a carrier to

make payments under a managed care plan based on its claims payment policies.