Nevada Revised Statutes 695C.260 – Establishment of system for resolving complaints and system for conducting external review of adverse determinations required
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Each health maintenance organization shall establish:
Terms Used In Nevada Revised Statutes 695C.260
- Health maintenance organization: means any person which provides or arranges for provision of a health care service or services and is responsible for the availability and accessibility of such service or services to its enrollees, which services are paid for or on behalf of the enrollees on a periodic prepaid basis without regard to the dates health services are rendered and without regard to the extent of services actually furnished to the enrollees, except that supplementing the fixed prepayments by nominal additional payments for services in accordance with regulations adopted by the Commissioner shall not be deemed to render the arrangement not to be on a prepaid basis. See Nevada Revised Statutes 695C.030
1. A system for resolving complaints which complies with the provisions of NRS 695G.200 to 695G.230, inclusive; and
2. A system for conducting external reviews of adverse determinations that complies with the provisions of NRS 695G.241 to 695G.310, inclusive.