NRS 695G.303 Independent review organization and health carrier required to maintain written records; submission of report upon request.

391 words·~2 min read·/nv/chapter-695g-managed-care/695g-303

A research copy — for the controlling text, always check the official state or federal source. Not legal advice.

1. An independent review organization assigned pursuant to NRS 695G.251 , 695G.271 or 695G.275 to conduct an external review shall maintain written records, aggregated for each state and for each health carrier, on all requests for which it conducted an external review during a calendar year and, upon request, submit a report to the Office for Consumer Health Assistance in a format specified by the Commissioner.

2. The report must include, aggregated for each state and for each health carrier:

(a)The total number of requests for external review;

(b)The number of requests for external review resolved and, of those resolved, the number upholding the adverse determination and the number reversing the adverse determination;

(c)The average length of time for resolution;

(d)A summary of the types of coverages or cases for which an external review was sought;

(e)The number of external reviews that were terminated as the result of a reconsideration by the health carrier of its adverse determination after receipt of additional information from the covered person or the covered person’s authorized representative pursuant to subsection 4 of NRS 695G.251 and subsection 32 of NRS 695G.275 ; and

(f)Any other information the Office for Consumer Health Assistance may request or require.

3. An independent review organization shall retain the written records required pursuant to this section for at least 3 years.

4. Each health carrier shall maintain written records, aggregated for each state and for each type of health benefit plan offered by the health carrier, on all requests for external review for which the health carrier receives notice from the Office for Consumer Health Assistance and, upon request, submit a report to the Office for Consumer Health Assistance in a format specified by the Commissioner.

5. The report must include, aggregated for each state and for each type of health benefit plan:

(a)The total number of requests for external review;

(b)Of the total number of requests for external review, the number of requests determined to be eligible for external review; and

(c)Any other information the Office for Consumer Health Assistance may request or require.

6. A health carrier shall retain the written records required pursuant to this section for at least 3 years.