Nevada Administrative Code
Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations
ADMINISTRATION OF ORGANIZATION
Section 695C.230 - System for resolving complaints of enrollees of health maintenance organizations: Requirements for approval

Universal Citation: NV Admin Code 695C.230

Current through December 12, 2024

1. To obtain approval of a system for resolving complaints of enrollees concerning health care services covered by a health maintenance organization as required pursuant to NRS 695C.260 and 695G.200, the health maintenance organization must submit to the Division:

(a) The name and title of the employee responsible for the system;

(b) A description of the procedure used to notify an enrollee of the decision regarding his or her complaint; and

(c) A copy of the explanation of rights and procedures which is to be provided to an enrollee pursuant to NRS 695C.260 and 695G.230.

2. A health maintenance organization may not delegate the responsibility for the operation of a system to resolve complaints to a delivery system intermediary.

Added to NAC by Comm'r of Insurance, eff. 6-11-86; A 5-27-92; R129-96, 10-29-97; R132-98, 3-30-99; R148-99, 1-27-2000

NRS 679B.130, 695C.260

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