NRS 687B.697
Access to services and contractual discounts of a provider of health care: Obligations of health carrier and third parties concerning remittance advice or explanation of payment

  • requirements of third party.

1.

A health carrier and third parties are obligated to comply with NRS 687B.694 and 687B.696 concerning the services referenced on a remittance advice or explanation of payment. A provider of health care may refuse the discount taken on the remittance advice or explanation of payment if the discount is taken without a contractual basis or in violation of NRS 687B.693 or 687B.695. An error in the remittance advice or explanation of payment may be corrected not more than 30 days after given notice of the error by the provider of health care.

2.

A health carrier may not lease, rent or otherwise grant to a third party, access to a provider network contract unless the third party accessing the provider network contract is:

(a)

A payer or third party, administrator or other entity that administers or processes claims on behalf of the payer;

(b)

A preferred provider of health care organization or preferred provider of health care network, including a physician organization or a physician-hospital organization; or

(c)

An entity engaged in the electronic claims transport between the health carrier and the payer that does not provide access to the services and discounts of a provider of health care to any other third party.

Source: Section 687B.697 — Access to services and contractual discounts of a provider of health care: Obligations of health carrier and third parties concerning remittance advice or explanation of payment; requirements of third party., https://www.­leg.­state.­nv.­us/NRS/NRS-687B.­html#NRS687BSec697.

687B.600
Definitions. 687B.605
“Covered person” defined. 687B.607
“Direct notification” defined. 687B.610
“Evidence of coverage” defined. 687B.615
“Health benefit plan” defined. 687B.620
“Health care services” defined. 687B.625
“Health carrier” defined. 687B.630
“Intermediary” defined. 687B.635
“Medically necessary” defined. 687B.640
“Network” defined. 687B.645
“Network plan” defined. 687B.650
“Participating provider of health care” defined. 687B.655
“Primary care physician” defined. 687B.658
“Provider network contract” defined. 687B.660
“Provider of health care” defined. 687B.664
“Third party” defined. 687B.665
“Utilization review” defined. 687B.670
Requirements to offer or issue network plan. 687B.675
Provision of information to the Office for Consumer Health Assistance. 687B.680
Health carrier to notify participating providers of health care of services covered by network plan. 687B.690
Required provisions in contract between participating provider of health care and health carrier. 687B.693
Access to services and contractual discounts of a provider of health care: Inapplicability of provisions. 687B.694
Access to services and contractual discounts of a provider of health care: Requirements for granting access 687B.695
Access to services and contractual discounts of a provider of health care: Access by third parties. 687B.696
Access to services and contractual discounts of a provider of health care: Information required to be provided by third parties. 687B.697
Access to services and contractual discounts of a provider of health care: Obligations of health carrier and third parties concerning remittance advice or explanation of payment 687B.700
Participating provider of health care to continue delivery of services if health carrier or intermediary insolvent or ceases operations 687B.710
Provisions to be construed in favor of covered person, survive termination of contract and supersede certain contrary agreements. 687B.720
Notice of insolvency or cessation of operations of health carrier or intermediary. 687B.730
Health carrier to provide notice of administrative policies and programs. 687B.740
Inducement to provide less than medically necessary health care services prohibited. 687B.750
Health carrier not to prohibit certain actions by participating provider of health care. 687B.760
Health records 687B.770
Assignment or delegation of rights and responsibilities without prior written consent prohibited. 687B.780
Participating provider of health care to furnish covered services to all covered persons 687B.790
Health carrier to notify participating provider of health care of obligation to collect coinsurance, copayment or deductible or notify covered person of obligation for services not covered. 687B.800
Retaliation for good faith reporting to state or federal authority prohibited. 687B.810
Health carrier to allow participating provider of health care to determine whether a person is a covered person. 687B.820
Procedures for resolution of disputes. 687B.830
Contract for purposes of network plan prohibited from conflicting with network plan or law 687B.840
Health carrier to notify participating provider of health care of status and inclusion on certain lists maintained by health carrier. 687B.850
Regulations.
Last Updated

Feb. 5, 2021

§ 687B.697’s source at nv​.us