17B:32B-15 - Condition for receipt by providers of payments - New Jersey Statutes

17B:32B-15  Condition for receipt by providers of payments.

15.  As a condition of receiving payment directly from the association for an eligible claim against an insolvent organization, a provider shall agree to forgive that organization of one-third of the unpaid contractual obligation incurred prior to insolvency, which would otherwise be paid by the organization had it not been insolvent.  The foregoing shall not apply to any portion of an eligible claim owed to a provider by another insurer, health maintenance organization, or other payer through a coordination of benefits provision.  The association is not bound by an assignment of benefits executed with respect to the coverage provided by the insolvent organization.  The association may aggregate all eligible claims owed providers when negotiating direct payment of eligible claims of all covered individuals.  Nothing in this act shall be construed to preclude any provider from collecting moneys owing to the provider from a self-insured benefit plan that contracted with an insolvent organization to pay claims on an administrative services only basis.

L.2000,c.12,s.15.