Section 695D.510 - Requirements for approvalTo obtain approval of a system for resolving complaints of members concerning services covered by an organization from the Commissioner as required pursuant to NAC 695D.500, an organization must:
1. Demonstrate that the system will resolve oral and written complaints concerning:(a) Payment or reimbursement for covered services;(b) The availability, delivery or quality of covered services, including, without limitation, adverse determinations made pursuant to utilization review; and(c) The terms and conditions of the policies of a member.2. Submit to the Division:(a) The name and title of the employee responsible for the system;(b) A description of the procedure used to notify a member of the decision regarding his or her complaint; and(c) A copy of the explanation of rights and procedures which is to be provided to members pursuant to NAC 695D.520.Nev. Admin. Code § 695D.510
Added to NAC by Comm'r of Insurance by R132-98, eff. 3-30-99