Prior-Authorization

Pre-Authorization Law Now In Effect

Jan 23, 2025
A new law that streamlines the pre-authorization process for health insurance carriers in the state, went into effect this month. Here are the main provisions dentists should know about.

In January 2024, Governor Murphy signed Assembly Bill 1255/Senate Bill 1794 into law. This legislation, which streamlines the pre-authorization process for health insurance carriers in the state, went into effect this month. 

The law aims to improve patients' access to timely care. Here are the main provisions dentists should know about:

• Deadlines for Decisions: Insurance companies must decide on pre-authorization requests within 24 hours for urgent cases and 72 hours for non-urgent cases.

• Validity of Approvals: Prior authorizations for long-term or chronic condition treatments remain valid for 180 days.

• Specialist Requirement for Denials: Denials or limitations of treatments must be made by a physician of the same specialty as the requesting doctor.

• Transition Period for New Health Plans: Patients switching health plans can continue care approved under the old plan for 60 days.

• Impact: Applies only to state-regulated insurance plans, covering about one-third of the state population, including the State Health Benefits Program and the School Employees’ Health Benefits Program.

 

NJDA Members with questions about this law, please reach out to NJDA Dental Practice & Health Policy Coordinator Javier Perez at jperez@njda.org. 

Media inquiries should be directed to NJDA Director of Advocacy & Health Affairs Orville Morales at omorales@njda.org.