peer review program

About Peer Review

Peer Review is an alternative dispute resolution mechanism which addresses differences that may arise between a patient and dentist, or a dentist and third party payer. Special committees of dentists, who are selected because of their objectivity, volunteer their services to deal impartially with two specific areas only:

     1) Appropriateness of care:  Was the treatment necessary?
     2) Quality of treatment:  Did the treatment fall within parameters of acceptable care? 

Participation in peer review is voluntary. Each party must sign a consent form, indicating his/her willingness to cooperate with the committee and accept its decision as binding and enforceable under New Jersey law. By signing the consent form, both parties waive their rights to have the dispute settled in a court of law. Each party receives a copy of the other's signed consent form.

  • Structure of the Peer Review System
  • Peer Review Procedures
  • General Information

request for mediation

To request mediation, please complete the form below or download a pdf version.

Request for Mediation Form

Date:
Case #:
(to be assigned by NJDA)
After review of your request and receipt of related documentation, a mediator will be assigned and will contact you to discuss your concerns and help resolve the issue. While a refund of the charges you have paid is one of the options that may be recommended by the mediator, a request for a refund should not be made in writing or on this form. 

Patient Information

Dentist Information

Thank you for addressing your concerns to the New Jersey Dental Association. Below, please provide a phone number and the best time of day for the mediator to contact you. If you have any questions, please call the NJDA at 732-821-9400.
In order that a complete review be performed, I authorize the release, to this committee, of any dental records or information by anyone who has examined me previously. I further give my permission for the committee to perform a clinical examination if necessary. I understand that the committee’s examination, if performed, will be limited to an evaluation of the treatment in question and does not constitute a complete dental examination. 
"State":"NJ"