2011 Nevada Revised Statutes
Chapter 695G - Managed Care
NRS 695G.271 - Expedited approval or denial of request.

1. The Office for Consumer Health Assistance shall approve or deny a request for an external review of an adverse determination in an expedited manner not later than 72 hours after it receives proof from the provider of health care of the covered person that:

(a) The adverse determination concerns an admission, availability of care, continued stay or health care service for which the covered person received emergency services but has not been discharged from the facility providing the services or care; or

(b) Failure to proceed in an expedited manner may jeopardize the life or health of the covered person or the ability of the covered person to regain maximum function.

2. If the Office for Consumer Health Assistance approves a request for an external review pursuant to subsection 1, the Office for Consumer Health Assistance shall assign the request to an independent review organization not later than 1 working day after approving the request. Each assignment made by the Office for Consumer Health Assistance pursuant to this section must be completed on a rotating basis.

3. Within 24 hours after receiving notice of the Officer for Consumer Health Assistance assigning the request, the health carrier shall provide to the independent review organization all documents and materials specified in subsection 4 of NRS 695G.251.

4. An independent review organization that is assigned to conduct an external review pursuant to subsection 2 shall, if it accepts the assignment:

(a) Complete its external review not later than 48 hours after receiving the assignment, unless the covered person and the health carrier agree to a longer period;

(b) Not later than 24 hours after completing its external review, notify the covered person, the physician of the covered person, the authorized representative, if any, and the health carrier by telephone of its determination; and

(c) Not later than 48 hours after completing its external review, submit a written decision of its external review to the covered person, the physician of the covered person, the authorized representative, if any, and the health carrier.

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