New Jersey § 52:14-17

§ 52:14-17.

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.