Current through September 16, 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
