New Jersey § 52:17b-198

§ 52:17b-198.

Two or more independent physicians or dentists who are practicing in the service area

of a carrier may jointly negotiate with a carrier and engage in related joint activity,

as provided in this act, regarding non-fee-related matters which may affect patient

care, including, but not limited to, any of the following: a. the definition of medical necessity and other conditions of coverage; b. utilization management criteria and procedures; c. clinical practice guidelines; d. preventive care and other medical management policies; e. patient referral standards and procedures, including, but not limited to, those

applicable to out-of-network referrals; f. drug formularies and standards and procedures for prescribing off-formulary drugs; g. quality assurance programs; h. respective physician or dentist and carrier liability for the treatment or lack

of treatment of covered persons; i. the methods and timing of payments; j. other administrative procedures, including, but not limited to, eligibility verification

systems and claim documentation requirements for covered persons; k. credentialing standards and procedures for the selection, retention and termination

of participating physicians or dentists; l. mechanisms for resolving disputes between the carrier and physicians or dentists,

including, but not limited to, the appeals process for utilization management and

credentialing determinations; m. the health benefits or dental plans sold or administered by the carrier in which

the physicians or dentists are required to participate; n. the formulation and application of reimbursement methodology; o. the terms and conditions of physician or dentist contracts, including, but not

limited to, all products clauses, and the duration and renewal provisions of the contract;

and p. the inclusion or alteration of a contractual term or condition, except when the

inclusion or alteration is required by a federal or State regulation concerning that

term or condition; however, the restriction shall not limit a physician's or dentist's

rights to jointly petition the federal or State government, as applicable, to change

the regulation.