17:48G-4 - Inapplicability of act relative to certain decisions of insurers, third party administrators - New Jersey Statutes

17:48G-4  Inapplicability of act relative to certain decisions of insurers, third party administrators.
7.This act shall not be construed:

a.To regulate insurers' or third party administrators' making any decision, including, but not limited to, a decision concerning benefit or insurance coverage, that does not involve the making of a dental decision;

b.To regulate insurers' or third party administrators' use of a protocol for denying or limiting benefit payments for dental services where the protocol:

(1)has been approved for use by a dentist who is duly licensed in this State or who has been issued a limited registration certificate pursuant to section 4 of this act; and

(2)does not involve evaluation of an individual patient's dental care or condition; or

c.To regulate the application of contract limitations and exclusions, the credentialing of dentists or the conduct of retrospective fraud reviews.

L.2007, c.259, s.7.