Nevada Administrative Code
Chapter 695C - Health Maintenance Organizations; Provider-Sponsored Organizations
GENERAL PROVISIONS
Section 695C.025 - "Delivery system intermediary" defined

Universal Citation: NV Admin Code 695C.025

Current through December 31, 2024

1. "Delivery system intermediary" means a partnership, association, corporation or other legal entity which enters into a contract with an organization to provide health care services. The term includes:

(a) An entity jointly owned and controlled by a hospital and a physician; and

(b) An entity primarily owned and controlled by physicians.

2. The term does not include:

(a) A provider who enters into a contract with an organization to provide health care services, if that provider furnishes those services directly to enrollees.

(b) A group practice, if the group practice primarily uses only its employees, partners or shareholders to provide health care services.

(c) An organization.

(d) A prepaid limited health service organization.

(e) A provider or entity whose contract with an organization provides that:
(1) The organization assumes financial responsibility for any claims presented for payment to the provider or entity by a provider for covered health care services furnished to a subscriber or an enrollee if those claims are not paid by the provider or entity as provided by law or by the contract between the provider and the organization;

(2) The organization retains the premiums paid and the responsibility for the payment of claims presented;

(3) All denials for health care services remain the responsibility of the organization; and

(4) The organization maintains the appropriate amount of reinsurance.

Added to NAC by Comm'r of Insurance by R129-96, eff. 10-29-97

NRS 679B.130

Disclaimer: These regulations may not be the most recent version. Nevada may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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