There is a newer version of the Nevada Revised Statutes
2010 Nevada Code
TITLE 57 INSURANCE
Chapter 695G Managed Care
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GENERAL PROVISIONS
- NRS 695G.010 Definitions.
- NRS 695G.012 "Adverse determination" defined.
- NRS 695G.014 "Authorized representative" defined.
- NRS 695G.016 "Clinical peer" defined.
- NRS 695G.018 "External review organization" defined.
- NRS 695G.020 "Health care plan" defined.
- NRS 695G.030 "Insured" defined.
- NRS 695G.040 "Managed care" defined.
- NRS 695G.050 "Managed care organization" defined.
- NRS 695G.055 "Medically necessary" defined.
- NRS 695G.060 "Primary care physician" defined.
- NRS 695G.070 "Provider of health care" defined.
- NRS 695G.080 "Utilization review" defined.
- NRS 695G.090 Applicability. [Effective through December 31, 2010.]
- NRS 695G.090 Applicability. [Effective January 1, 2011.]
- NRS 695G.095 Offering policy of health insurance for purposes of establishing health savings account.
- NRS 695G.100 Documents treated as public record. ADMINISTRATION OF MANAGED CARE ORGANIZATIONS
- NRS 695G.110 Medical director must be physician licensed in this State.
- NRS 695G.120 Utilization review: Written policies and procedures; subcontracting.
- NRS 695G.125 Contracts with certain federally qualified health centers.
- NRS 695G.130 Report regarding methods for reviewing quality of health care services: Requirements; availability for public inspection.
- NRS 695G.140 Responsibility for money in fiduciary relationship to insured. COVERAGE BY MANAGED CARE ORGANIZATIONS
- NRS 695G.150 Authorization of recommended and covered health care services required.
- NRS 695G.160 Written criteria concerning coverage of health care services and standards for quality of health care services.
- NRS 695G.163 Coverage for prescription drugs: Provision of notice and information regarding use of formulary.
- NRS 695G.164 Required provision concerning coverage for continued medical treatment.
- NRS 695G.1645 Required provision concerning coverage for autism spectrum disorders. [Effective January 1, 2011.]
- NRS 695G.166 Required provision concerning coverage for prescription drug previously approved for medical condition of insured.
- NRS 695G.168 Required provision concerning coverage for screening for colorectal cancer.
- NRS 695G.170 Required provision concerning coverage for medically necessary emergency services; prohibitions.
- NRS 695G.171 Required provision concerning coverage for human papillomavirus vaccine.
- NRS 695G.173 Required provision concerning coverage for treatment received as part of clinical trial or study.
- NRS 695G.175 Certain actions of managed care organization prohibited.
- NRS 695G.177 Required provision concerning coverage for prostate cancer screening. QUALITY ASSURANCE PROGRAM
- NRS 695G.180 Quality assurance program: Requirements; written description; informing providers; necessary staff; review; responsibility for activities.
- NRS 695G.190 Quality improvement committee: Administration; duties. SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS
- NRS 695G.200 Approval; requirements; assistance for persons filing complaints; examination.
- NRS 695G.210 Review board; appeal; right to expedited review of complaint; notice to insured.
- NRS 695G.220 Annual report; managed care organization to maintain records of complaints concerning something other than health care services.
- NRS 695G.230 Written notice to insured explaining rights of insureds regarding decision to deny coverage; notice to insured when organization denies coverage of health care service. EXTERNAL REVIEW OF ADVERSE DETERMINATION
- NRS 695G.241 Adverse determination deemed final for purpose of submitting to external review organization.
- NRS 695G.251 Request for review; assignment of external review organization; provision of documents relating to adverse determination to external review organization.
- NRS 695G.261 Review of documents by external review organization; decision of external review organization.
- NRS 695G.271 Expedited approval or denial of request.
- NRS 695G.280 Basis for decision of external review organization.
- NRS 695G.290 Decision in favor of insured binding on managed care organization; limitation of liability; cost for external review organization.
- NRS 695G.300 Submission of complaint of insured to external review organization.
- NRS 695G.310 Annual report; requirements. PROHIBITED ACTS
- NRS 695G.400 Managed care organization prohibited from interfering in or restricting certain communications.
- NRS 695G.405 Managed care organization prohibited from denying coverage solely because insured was intoxicated or under the influence of controlled substance; exceptions.
- NRS 695G.410 Certain actions taken against provider solely because provider advocates on behalf of patient, assists patient or reports violation of law prohibited.
- NRS 695G.420 Offering or paying financial incentive to provider to deny, reduce, withhold, limit or delay medically necessary services prohibited.
- NRS 695G.430 Contracts between managed care organization and provider of health care: Form for obtaining information on provider of health care; modification; schedule of fees.
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