Nevada Revised Statutes 679B.124 – Denial of application of provider of health care to be included in network of providers of health carrier: Form letter required for notification of provider by health carrier; health carrier to make copy of form sen…
1. The Commissioner shall:
Terms Used In Nevada Revised Statutes 679B.124
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
(a) Develop, prescribe and make available on an Internet website maintained by the Division a form letter that a health carrier must use to notify a provider of health care of the denial of his or her application to be included in the network of providers of the health carrier. The form letter must include, without limitation, a place for the health carrier to explain the reason for the denial of the application.
(b) Hold hearings to solicit public input when developing the form letter described in paragraph (a) and consider such input when developing the form letter.
2. A health carrier shall:
(a) Maintain a copy of each form letter sent to a provider of health care pursuant to subsection 1 and make each copy available to the Commissioner upon request; and
(b) As frequently as required by the Commissioner pursuant to subsection 3, submit to the Commissioner a report summarizing the form letters sent to a provider of health care pursuant to subsection 1.
3. The Commissioner shall determine the information that is required to be included in a report submitted pursuant to subsection 2 and the frequency with which the report must be submitted by the health carrier to the Commissioner.
4. Except as otherwise provided in subsection 5, the report submitted to the Commissioner pursuant to subsection 2, any form letter requested by the Commissioner pursuant to that subsection and the information contained therein are confidential.
5. The Commissioner shall:
(a) Annually compile a report using aggregated data from the reports and form letters collected pursuant to subsection 2 concerning trends in the denial of applications of providers of health care to be included in the network of providers of a health carrier. The report must include, without limitation, the number of total denials, the number of denials for different types of providers of health care, the number of denials by different carriers and the reasons for such denials.
(b) Post the report on an Internet website maintained by the Division.
(c) Submit the report to the Governor and the Director of the Legislative Counsel Bureau for transmittal to the Legislature.
6. As used in this section, ‘health carrier’ means an entity subject to the insurance laws and regulations of this State, or subject to the jurisdiction of the Commissioner, that contracts or offers to contract to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services, including, without limitation, a sickness and accident health insurance company, a health maintenance organization, a nonprofit hospital and health service corporation or any other entity providing a plan of health insurance, health benefits or health care services.