NRS 616C.137
Denial of payment for unrelated services: Requirements for notification

  • liability of injured employee
  • appeal.

1.

If an insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 denies payment for some or all of the services itemized on a statement submitted by a provider of health care on the sole basis that those services were not related to the employee’s industrial injury or occupational disease, the insurer, organization for managed care or employer shall, at the same time that it sends notification to the provider of health care of the denial, send a copy of the statement to the injured employee and notify the injured employee that it has denied payment. The notification sent to the injured employee must:

(a)

State the relevant amount requested as payment in the statement, that the reason for denying payment is that the services were not related to the industrial injury or occupational disease and that, pursuant to subsection 2, the injured employee will be responsible for payment of the relevant amount if the injured employee does not, in a timely manner, appeal the denial pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, or appeals but is not successful.

(b)

Include an explanation of the injured employee’s right to request a hearing to appeal the denial pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, and a suitable form for requesting a hearing to appeal the denial.

2.

An injured employee who does not, in a timely manner, appeal the denial of payment for the services rendered or who appeals the denial but is not successful is responsible for payment of the relevant charges on the itemized statement.

3.

To succeed on appeal, the injured employee must show that the:

(a)

Services provided were related to the employee’s industrial injury or occupational disease; or

(b)

Insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 gave prior authorization for the services rendered and did not withdraw that prior authorization before the services of the provider of health care were rendered.

Source: Section 616C.137 — Denial of payment for unrelated services: Requirements for notification; liability of injured employee; appeal., https://www.­leg.­state.­nv.­us/NRS/NRS-616C.­html#NRS616CSec137.

616C.085
Duties of employer when employee injured: First aid 616C.087
Selection of physician or chiropractor: Legislative declaration regarding rights of injured employee 616C.090
Selection of physician or chiropractor: Establishment, maintenance and update of panel of physicians and chiropractors 616C.095
Duty of physician or chiropractor to advise injured employee of rights. 616C.098
Use by physician or chiropractor of certain phrases relating to causation of industrial injury or occupational disease. 616C.100
Additional determination of percentage of disability permitted if cost paid by injured employee 616C.105
Requirements for designation of chiropractor to rate permanent partial disabilities. 616C.115
Prescription of generic drugs required 616C.117
Prescription of drugs dispensed directly to injured employee 616C.120
Employee may elect treatment through prayer in lieu of medical treatment. 616C.125
Insurer may contract with suppliers for provision of services and goods to injured employees. 616C.130
Insurer’s payment to physician or chiropractor attending injured employee conditioned upon receipt of itemized statement and certificate. 616C.135
Liability of insurer for payment of charges for treatment related to industrial injury or occupational disease 616C.136
Action by insurer on bill from provider of health care 616C.137
Denial of payment for unrelated services: Requirements for notification 616C.138
Payment of provider of health care upon insurer’s denial of authorization or responsibility for treatment or other services provided 616C.140
Medical examination of claimant 616C.145
Independent medical examination of claimant
Last Updated

Jun. 24, 2021

§ 616C.137’s source at nv​.us