N.J. Admin. Code § 11:24B-5.7

Current through Register Vol. 56, No. 21, November 4, 2024

Section 11:24B-5.7 - Third-party rights

(a) There shall be a provision specifying that the carrier is a third party beneficiary of the provider agreement, with privity of contract, and a right to enforce the provisions of the provider agreement in the event that the ODS fails to do so, except that such a provision is not required for provider agreements between a carrier and an ODS (whose shareholders are composed solely of health care providers, if the ODS is certified or seeking certification solely for the provision of the performance of health care services by its shareholders).

(b) There shall be a provision in a provider agreement between a carrier and an ODS (whose shareholders are composed solely of health care providers, if the ODS is certified or seeking certification solely for the provision of the performance of health care services by its shareholders) specifying that the providers of the ODS that participate in the network of the carrier by virtue of the contract between the carrier and the ODS are third party beneficiaries of the provider agreement, with privity of contract, and a right to enforce the provisions of the provider agreement in the event that the ODS fails to do so.

(c) There shall be a provision in a provider agreement between a carrier and an ODS (whose shareholders are composed solely of health care providers, if the ODS is certified or seeking certification solely for the provision of the performance of health care services by its shareholders) that specifies that there is privity of contract between the carrier and each of the ODS' providers that participate in the carrier's network by virtue of the contract between the carrier and the ODS, and that the carrier shall have the right to enforce the terms of the contract against such providers in the event that the ODS fails to do so.

N.J. Admin. Code § 11:24B-5.7