Nevada Revised Statutes 687B.692 – Provider network contract: Circumstances in which health carrier prohibited from denying request to enter into contract from a provider of health care employed or accepting employment with medical school; grounds fo…
1. A health carrier which offers or issues a network plan may not deny a request from a provider of health care to enter into a provider network contract with the health carrier if the provider of health care:
Terms Used In Nevada Revised Statutes 687B.692
- Contract: A legal written agreement that becomes binding when signed.
(a) Meets and accepts the terms and conditions for participation in the network of the health carrier, including, without limitation:
(1) Meeting any credentialing requirement of the health carrier;
(2) Agreeing to all provisions of the provider network contract, including, without limitation, provisions setting forth the grounds and procedures for terminating providers of health care from participation in the network; and
(3) Agreeing to participate in a review of the performance and experience of the provider of health care at least once each year or as otherwise required by the health carrier;
(b) Is employed by or has accepted an offer of employment from a school of medicine or school of osteopathic medicine in this State to serve in a position where the provider of health care teaches students studying to become providers of health care or resident physicians at least 50 percent of the time the provider of health care is performing his or her duties for the school;
(c) Does not have a clinical practice already established in this State at the time the request to enter into a provider network contract is made; and
(d) Requests to be a participating provider of health care in the network of the health carrier.
2. A health carrier which offers or issues a network plan may deny a request from a provider of health care to enter into a provider network contract with the health carrier if:
(a) The health carrier contracts with a third party for the delivery of services to covered persons;
(b) Participating providers of health care are paid though capitation agreements; or
(c) Accepting the provider of health care into the network plan would disrupt existing provider network contracts.
3. A health carrier may terminate a provider network contract entered into pursuant to subsection 1 for any grounds authorized under the contract. Such grounds may include, without limitation, failure to maintain the employment described in paragraph (b) of subsection 1 or issues of inconsistency with other participating providers of health care with regard to:
(a) Access for covered persons to the services of the provider of health care;
(b) The cost of the services of the provider of health care;
(c) The quality of care provided by the provider of health care; or
(d) Other issues relating to the utilization of the services of the provider of health care.