Current through December 12, 2024
1. To request a list of randomly selected
arbitrators pursuant to subsection 3 of
NRS
439B.754 to arbitrate a dispute over a claim
of less than $5,000, an out-of-network provider must submit a request to the
Department. If the out-of-network provider submits the request because the
third party has refused or failed to pay the additional amount requested by the
out-of-network-provider pursuant to subsection 2 of
NRS
439B.754, the out-of-network provider must
submit the request by:
(a) If the third party
refused to pay the additional amount, not later than 30 business days after the
date on which the third party notifies the out-of-network provider of the
refusal.
(b) If the third party
failed to pay the additional amount for 30 business days after receiving a
request for the additional amount, not later than 30 business days after that
date.
2. A request
submitted pursuant to subsection 1 must be in the form prescribed by the
Department and include, without limitation:
(a) The date on which the medically necessary
emergency services to which the complaint pertains were provided and the type
of medically necessary emergency services provided;
(b) The contact information for and location
of the out-of-network provider that provided the medically necessary emergency
services;
(c) The type and
specialty of each health care practitioner who provided the medically necessary
emergency services;
(d) The type of
third party that provides coverage for the covered person to whom the medically
necessary emergency services were rendered and contact information for that
third party; and
(e) Documentation
of:
(1) The date on which the out-of-network
provider received payment from the third party pursuant to subsection 2 of
NRS
439B.748 or paragraph (c) of subsection 1 or
subsection 2 of NRS
439B.751, as applicable, and the amount of
payment received;
(2) The date on
which the out-of-network provider requested additional payment from the third
party pursuant to subsection 2 of
NRS
439B.754, and the additional amount
requested; and
(3) The date on
which the third party refused to pay the additional amount, if
applicable.
3. If the Department does not receive a
request pursuant to subsection 1 within the prescribed time, the out-of-network
provider shall be deemed to have accepted the payment received from the third
party pursuant to subsection 2 of
NRS
439B.748 or paragraph (c) of subsection 1 or
subsection 2 of NRS
439B.751, as applicable, as payment in full
for the medically necessary emergency services.
4. Not later than 10 business days after
receiving a request pursuant to subsection 1, the Department shall notify the
out-of-network provider in writing of the receipt of the request. Not later
than 20 business days after providing such notification, the Department shall:
(a) Review the request and verify the
information contained therein; and
(b) Notify the out-of-network provider in
writing of any additional information necessary to complete or clarify the
request.
5. The
Department will approve a request submitted pursuant to subsection 1 not later
than 5 business days after determining that the request includes the
documentation required by subsection 2 and is otherwise complete and clear. Not
later than 5 business days after approving a request, the Department shall:
(a) Notify the out-of-network provider and
the third party in writing of the approval.
(b) Randomly select five employees of the
Office for Consumer Health Assistance of the Department who are qualified to
arbitrate the dispute and ensure that those arbitrators do not have a conflict
of interest that would prevent the arbitrator from impartially rendering a
decision. For the purposes of this paragraph, a conflict of interest shall be
deemed to exist if the arbitrator, or any person affiliated with the
arbitrator:
(1) Has direct involvement in the
licensing, certification or accreditation of a health care facility, insurer or
provider of health care;
(2) Has a
direct ownership interest or investment interest in a health care facility,
insurer or provider of health care;
(3) Is employed by, or participating in, the
management of a health care facility, insurer or provider of health care;
or
(4) Receives or has the right to
receive, directly or indirectly, remuneration pursuant to any arrangement for
compensation with a health care facility, insurer or provider of health
care.
(c) Provide to the
out-of-network provider and the third party a written list of five arbitrators
selected pursuant to paragraph (b) who have been determined not to have a
conflict of interest.
Added
to NAC by Dept of Human Resources, by
R101-19A,
eff. 9/19/2022;
Added to NAC by Dept of Human Resources, by
R101-19A,
eff. 9/19/2022
NRS
439B.754
