S 3042 A 4619
Creates subaccounts for SHBP and SEHBP health care services and prescription drug claims; requires procurement by State of third-party medical claims review
NJEA supports A-4619 (Pintor Marin, Wirths)/S-3042 (Sarlo, Oroho). These bills require that the state procure a third party medical claims reviewer to examine claims processing in the State Health Benefits Program (SHBP) and the School Employees’ Health Benefits Program (SEHBP). The oversight and review of the claims process will help ensure that the state is not overpaying claims.
These bills require the Department of Treasury to procure a third-party medical claims reviewer who shall oversee the adjudication and processing of direct payments for health care services in the state plans. The reviewer cannot be the carrier, or a subsidiary of the carrier. These bills also require that the state will have access to health insurance claims data, which will allow the state to better understand health care usage.
Having a third-party medical claims reviewer will block overpayments. This should provide cost savings to the state. Having access to data will help improve plan design for state employees.
NJEA asks that you support these bills.
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