N.J. Admin. Code § 11:6-2.10 - WCMCO provider agreements
(a) No provider
agreement or amendment thereto may be used until a copy of the form of
agreement has first been filed with the Department of Banking and Insurance.
Thereafter, the form of agreement may be used until or unless a disapproval is
received from the Department.
(b)
All forms of agreements and amendments shall be filed at least 60 days prior to
the planned date of use, and shall include a unique identifying form number in
the bottom left hand corner.
(c)
Submission of amended forms of agreements shall include two copies of the
amended agreement(s) or page(s). One copy shall be marked to show changes to
the existing form, and one copy shall be unmarked.
(d) Agreements with providers shall state:
1. The term of the agreement;
2. The services and supplies to be provided
by the provider and a list of the contractual amounts or rates that will be
paid to the provider for those services and supplies;
3. That providers shall not discriminate in
their treatment of covered persons;
4. That the provider will hold the covered
person harmless for the cost of any service or supply for which the carrier or
intermediary provides benefits, whether or not the provider believes its
compensation for the service or supply from the carrier or intermediary is made
in accordance with the reimbursement provision of the provider agreement, or is
otherwise inadequate; and
5. That
the providers shall maintain malpractice insurance coverage in an amount not
less than $ 1,000,000 per occurrence and $ 3,000,000 in the
aggregate.
Notes
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