NJ S3298

Health insurers must annually report and publicly disclose data on claims submitted, denied, appealed, and overturned, as well as prior authorization approvals and denials, with the Department of Banking and Insurance making this information publicly available

Payers who deny at least 20% of claims without proper justification in a year must return to covered persons the full cost they paid for denied services as a penalty

Every claim must be reviewed by at least one medical director, and all denial notices must include the reviewer's personal denial rate, average claim review time, and instructions for accessing consumer assistance through the Department of Banking and Insurance

Health insurers must publicly disclose on their websites whether they use automated utilization management systems (including AI-based systems) and how many claims were reviewed using such systems in the previous year

The Department of Banking and Insurance is authorized to audit payers' automated utilization management systems at any time, with the ability to contract third-party entities to perform audits