NJ S1029: Requires collection of data by health insurers regarding health insurance claims and decisions made using automated utilization management systems.

In one paragraph

New Jersey's S1029 would require health insurers (payers) to keep and report data on claims, including denials, appeals and prior-authorization outcomes, and would make them disclose whether they use an automated utilization management system (a system that may use AI to recommend or decide coverage) and how many claims it reviewed. A payer determined to have denied at least 20 percent of a year's claims without proper justification would have to repay covered persons for the denied services. Referred to the Senate Commerce Committee January 13, 2026; it has not passed either chamber.

Plain-English summary, written with AI assistance. The official text controls.

What it means for business

None yet: the bill is pending. If enacted, health insurers and carriers would have to report claims data, have a medical director review each claim, disclose use of automated utilization management, and accept audits of that system.

Key provisions

1. 1Payers would keep, and the Department of Banking and Insurance would publish, annual data on claims: in-network and out-of-network claims, denied claims that were appealed and appeals sustained or overturned, prior-authorization approvals and denials, and the procedures most often denied per specialty
2. 2A payer found to have denied at least 20 percent of claims in a year without proper justification would have to return to a covered person the amount the person paid for the services denied
3. 3Every claim would have to be reviewed by at least one medical director employed by or contracted with the payer
4. 4Payers would publicly post claim rejection rates and average review times, and denial notices would show the reviewing physician's or medical director's denial rate and average review time and how to reach Department consumer assistance
5. 5A carrier would have to post whether it uses an automated utilization management system and how many claims it reviewed with it in the previous year
6. 6The Department could audit a payer's automated utilization management system and its data at any time, using a third party if needed
7. 7Would take effect on the first day of the thirteenth month after enactment, for plans delivered, issued, executed or renewed on or after that date
8. 8Status: introduced and referred to the Senate Commerce Committee January 13, 2026; no further action

Latest legislative action

Jan 13, 2026. Introduced in the Senate, Referred to Senate Commerce Committee

Sponsors (showing 5 of 19)

Roll call votes