New Jersey § 52:14-17

§ 52:14-17.

The Legislature finds and declares that: a. The cost of health care in this country has been increasing at a pace that will

make our current system of health care delivery unsustainable on its present trajectory. b. As health care costs continue to rise more quickly than the average annual income,

those costs displace other priorities for individuals, such as saving for retirement

or their children's education, and even discourage people from obtaining recommended

health care. The litany of research in this area has demonstrated that all necessary action must

be taken to reduce costs wherever possible. c. One way to reduce costs is to increase the oversight that a self-insured employer,

such as the State, exercises over health care programs, as occurs when hiring a third-party

medical claims reviewer to examine claims processing. d. Hiring a third-party medical claims reviewer to provide regular, frequent, and

ongoing review and oversight of the claims process, which process includes, but is

not limited to, the receipt, management, adjudication, and payment of claims, serves

the best interests of the State, participating employers, and the thousands of employees

and their dependents covered under the State Health Benefits Program and the School

Employees' Health Benefits Program. A third-party medical claims reviewer would act in the best interests of the State,

participating employers, and program participants, work toward identifying and eliminating

systemic errors, recover overpayments, and ensure that only the required and appropriate

amounts due and owing on claims are paid as a result of proper adjudication. e. For the purpose of facilitating greater efficiency and transparency in the adjudication

of health benefits claims to State employees, their eligible family members, and participating

local government and education employees and their eligible family members, the State

of New Jersey deems it fitting and crucial to procure a third-party medical claims

reviewer expeditiously, with a goal for implementation in the plan year beginning

in January of 2020.