New Jersey Statutes Title 52. State Government, Departments and Officers 52 § 14-17.30a

a. The cost of health care in this country has been increasing at a pace that will make our current system of health care delivery unsustainable on its present trajectory.

b. As health care costs continue to rise more quickly than the average annual income, those costs displace other priorities for individuals, such as saving for retirement or their children's education, and even discourage people from obtaining recommended health care. The litany of research in this area has demonstrated that all necessary action must be taken to reduce costs wherever possible.

c. One way to reduce costs is to increase the oversight that a self-insured employer, such as the State, exercises over health care programs, as occurs when hiring a third-party medical claims reviewer to examine claims processing.

d. Hiring a third-party medical claims reviewer to provide regular, frequent, and ongoing review and oversight of the claims process, which process includes, but is not limited to, the receipt, management, adjudication, and payment of claims, serves the best interests of the State, participating employers, and the thousands of employees and their dependents covered under the State Health Benefits Program and the School Employees' Health Benefits Program. A third-party medical claims reviewer would act in the best interests of the State, participating employers, and program participants, work toward identifying and eliminating systemic errors, recover overpayments, and ensure that only the required and appropriate amounts due and owing on claims are paid as a result of proper adjudication.

e. For the purpose of facilitating greater efficiency and transparency in the adjudication of health benefits claims to State employees, their eligible family members, and participating local government and education employees and their eligible family members, the State of New Jersey deems it fitting and crucial to procure a third-party medical claims reviewer expeditiously, with a goal for implementation in the plan year beginning in January of 2020.