§ 695G.261 — Review of documents by independent review organization; decision of independent review organization

Nevada § 695G.261

• Jurisdiction: Nevada
• Title 57: INSURANCE
• Ch. 695G: Managed

Text

1. Except as otherwise provided in NRS 695G.271 and 695G.275 , upon receipt of a request for an external review pursuant to NRS 695G.251 , the independent review organization shall, within 5 days after receiving the request:
(a) Review the request and the documents and materials submitted pursuant to NRS 695G.251 ; and
(b) Notify the covered person, the physician of the covered person and the health carrier if any additional information is required to conduct a review of the adverse determination. Such additional information must be provided within 5 days after receiving notice that the information is required to conduct a review of the adverse determination. The independent review organization shall forward to the health carrier, within 1 business day after receipt, any information received from a covered person or the physician of a covered person.
2. Except as otherwise provided in NRS 695G.271 and 695G.275 , the independent review organization shall approve, modify or reverse the adverse determination within 15 days after it receives the information required to make that determination pursuant to this section. The independent review organization shall submit a copy of its determination, including the reasons therefor, to:
(a) The covered person;
(b) The physician of the covered person;
(c) The authorized representative of the covered person, if any; and
(d) The health carrier.

Legislative History

(Added to NRS by 2003, 781 ; A 2011, 3413 )