Section 442.715 - Eligibility of providers under program1. To provide services to clients, physicians and other regular providers of services under the program must have executed a memorandum of understanding with the Division, except that providers who provide services one time or on a sporadic basis are not required to have executed a memorandum of understanding if they agree to accept reimbursement provided under the program as payment in full for those services. The memorandum of understanding must:(a) Require the physician or other provider to accept the rates of reimbursement set forth in NAC 442.751; and(b) Provide that households will not be billed by the provider for the remaining balance.2. Except in cases of emergency, providers must receive authorization before the delivery of a service to a patient, including, but not limited to, a patient for whom a determination of eligibility for Medicaid is pending, to be eligible for reimbursement for that service. Oral authorization for care must be followed by written authorization. Authorizations for services provided during the hours when the offices of the Bureau are closed may be issued retroactively if:(a) The client meets the eligibility requirements of the program; and(b) The Division is notified by the physician, hospital, medical facility or other provider of services within 72 hours after the services are provided.3. A physician must provide medical justification for and a description of the anticipated outcome of the services requested at the time he or she requests prior authorization.4. Medical treatment authorized for payment must relate to the primary diagnosis or diagnoses for which the applicant was accepted into the program.5. The following services covered by the primary physician's authorization do not require separate prior authorization:(a) Ambulance, if required by the authorized physician.(b) Anesthesiologists or anesthetists, except that the fees of the program prevail. The anesthesiologist or anesthetist must bill the insurance carrier or other third-party payer and the program directly. The client's household must not be billed for charges in excess of those allowed under the program.(c) Assistant surgeon, except that the fees of the program prevail. The assistant surgeon must bill the insurance carrier or other third-party payer and the program directly. The client's household must not be billed for charges in excess of those allowed under the program.(d) Laboratory services, except that the fees of the program prevail. The laboratory must bill the insurance carrier or other third-party payer and the program directly. The client's household must not be billed for charges in excess of those allowed under the program.Nev. Admin. Code § 442.715
Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98; R095-99, 11-29-99