NRS 695G.290 Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.
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NRS 695G.290 Decision in favor of covered person binding on health carrier; limitation of liability; cost for independent review organization.
1. If the determination of an independent review organization concerning an external review of an adverse determination is in favor of the covered person, the determination is final, conclusive and binding upon the health carrier.
2. An independent review organization or any clinical peer who conducts or participates in an external review of an adverse determination for the independent review organization is not liable in a civil action for damages relating to a determination made by the independent review organization if the determination is made in good faith and without gross negligence.
3. The cost of conducting an external review of an adverse determination pursuant to NRS 695G.241 to 695G.310 , inclusive, must be paid by the health carrier that made the adverse determination.