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Nevada Revised Statutes

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Nevada NRS
Ins.
Contracts of Ins.
Network Plans
“Medically necessary” defined.

Nevada Insurance
Sec. § 687B.635
“Medically necessary” defined.

Medically necessary has the meaning ascribed to it in NRS 695G.055.

Definitions.
“Covered person” defined.
“Direct notification” defined.
“Evidence of coverage” defined.
“Health benefit plan” defined.
“Health care services” defined.
“Health carrier” defined.
“Intermediary” defined.
“Medically necessary” defined.
“Network” defined.
“Network plan” defined.
“Participating provider of health care” defined.
“Primary care physician” defined.
“Provider network contract” defined.
“Provider of health care” defined.
“Third party” defined.
“Utilization review” defined.
Requirements to offer or issue network plan.
Provision of information to the Office for Consumer Health Assistance.
Health carrier to notify participating providers of health care of services covered by network plan.
Required provisions in contract between participating provider of health care and health carrier.
Access to services and contractual discounts of a provider of health care: Inapplicability of provisions.
Access to services and contractual discounts of a provider of health care: Requirements for granting access; termination; confidentiality.
Access to services and contractual discounts of a provider of health care: Access by third parties.
Access to services and contractual discounts of a provider of health care: Information required to be provided by third parties.
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.
Participating provider of health care to continue delivery of services if health carrier or intermediary insolvent or ceases operations; billing of covered person; termination of services.
Provisions to be construed in favor of covered person, survive termination of contract and supersede certain contrary agreements.
Notice of insolvency or cessation of operations of health carrier or intermediary.
Health carrier to provide notice of administrative policies and programs.
Inducement to provide less than medically necessary health care services prohibited.
Health carrier not to prohibit certain actions by participating provider of health care.
Health records; confidentiality.
Assignment or delegation of rights and responsibilities without prior written consent prohibited.
Participating provider of health care to furnish covered services to all covered persons; exception.
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.
Retaliation for good faith reporting to state or federal authority prohibited.
Health carrier to allow participating provider of health care to determine whether a person is a covered person.
Procedures for resolution of disputes.
Contract for purposes of network plan prohibited from conflicting with network plan or law; notice of provisions and incorporated documents; notice of changes.
Health carrier to notify participating provider of health care of status and inclusion on certain lists maintained by health carrier.
Regulations.

Source

Nev. Legislature

Last accessed

Feb. 5, 2021

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Location:https://nevada.public.law/statutes/nrs_687b.635.

Original Source: § 687B.635 — “Medically necessary” defined., https://www.leg.state.nv.us/NRS/NRS-687B.html#NRS687BSec635 (last accessed Feb. 5, 2021).