(a) A carrier shall develop written clinical criteria and protocols and shall base its UM determinations upon such clinical criteria and protocols.

1. The carrier shall develop its clinical criteria and protocols with the input of practicing physicians and other health care providers within the carrier’s network.

2. The carrier’s clinical criteria and protocols shall be based upon generally accepted medical standards.

(b) A carrier shall periodically review and update its clinical criteria and protocols, and maintain evidence of such periodic reviews.

(c) A carrier’s clinical criteria and protocols, as well as evidence of its most recent review and updating (if appropriate) of its clinical criteria and protocols, shall be made available, upon request, to covered persons and participating providers in relevant practice areas, as well as the Department.

(d) Notwithstanding (c) above, a carrier’s internal or proprietary quantitative thresholds for UM shall be confidential, and shall not be required to be released pursuant to (c) above.

See https://regulations.justia.com/states/new-jersey/title-11/chapter-24a/subchapter-4/