Nev. Admin. Code § 683A.600

Current through December 31, 2024

Section 683A.600 - Application for initial issuance of certificate: Generally

Except as otherwise provided in NAC 683A.610, an external review organization applying for the initial issuance of a certificate to conduct external reviews must submit to the Commissioner, on a form prescribed by the Commissioner, an application in writing and must provide to the Commissioner at the time of application:

1. A written statement that identifies:

(a) The number of external reviewers that the external review organization employs, contracts with or otherwise retains to conduct external reviews;

(b) The specialty of each external reviewer;

(c) Whether each external reviewer is certified by the entity that regulates his or her specialty; and

(d) The schedule of fees that the external review organization will charge to conduct an external review.

2. A written summary of the procedures that the external review organization will use to:

(a) Ensure that the external review organization conducts its activities in accordance with NRS 695G.241 to 695G.310, inclusive;

(b) Ensure that an external reviewer employed, contracted with or otherwise retained by the external review organization is qualified to conduct a specific external review;

(c) Ensure that a determination submitted for external review is a final adverse determination;

(d) Ensure that a final review is conducted in a timely manner in accordance with NRS 695G.251, 695G.261 and 695G.271;

(e) Ensure that the external review organization and any employee, agent or contractor of the external review organization does not have a conflict of interest as set forth in subsection 4 of NRS 683A.371; and

(f) Submit a copy of the determination regarding an external review to:

(1) The insured;

(2) The physician of the insured;

(3) The authorized representative of the insured, if any; and

(4) The managed care organization.

3. A written affidavit that:

(a) The information contained in the application and any accompanying materials are complete and correct;

(b) The external review organization will conduct external reviews in accordance with NRS 695G.241 to 695G.310, inclusive;

(c) The external review organization and any employee, agent or contractor of the external review organization will avoid a conflict of interest as set forth in subsection 4 of NRS 683A.371; and

(d) The external review organization is not affiliated with:

(1) A health care plan; or

(2) A national, state or local trade association.

4. All applicable fees required, including, without limitation, all applicable fees required pursuant to NAC 683A.640, for the issuance of a certificate to conduct external reviews.

Nev. Admin. Code § 683A.600

Added to NAC by Comm'r of Insurance by R128-03, eff. 2-12-2004; A by R103-09, 1-28-2010

NRS 679B.130, 683A.3715, 683A.372