Nevada Administrative Code
Chapter 695D - Organizations for Dental Care
SYSTEM FOR RESOLVING COMPLAINTS OF MEMBERS
Section 695D.510 - Requirements for approval
Universal Citation: NV Admin Code 695D.510
Current through September 16, 2024
To obtain approval of a system for resolving complaints of members concerning services covered by an organization from the Commissioner as required pursuant to NAC 695D.500, an organization must:
1. Demonstrate that the system will resolve oral and written complaints concerning:
(a)
Payment or reimbursement for covered services;
(b) The availability, delivery or quality of
covered services, including, without limitation, adverse determinations made
pursuant to utilization review; and
(c) The terms and conditions of the policies
of a member.
2. 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 a member 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 members pursuant to NAC
695D.520.
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99
NRS 679B.130, 695D.100
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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