Nac: Chapter 695G - Managed Care

Link to law: http://www.leg.state.nv.us/nac/NAC-695G.html
Published: 2015

[Rev. 11/22/2013 10:32:45

AM--2013]



[NAC-695G Revised Date: 11-04]

CHAPTER 695G - MANAGED CARE

GENERAL PROVISIONS

695G.010         Definitions.

695G.020         “Commissioner” defined.

695G.030         “Division” defined.

695G.040         “Managed care organization” defined.

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

695G.100         Requirements for approval.

695G.110         Annual report.

 

 

 

GENERAL PROVISIONS

      NAC 695G.010  Definitions. (NRS 679B.130)  As used

in this chapter, unless the context otherwise requires, the words and terms

defined in NAC 695G.020, 695G.030

and 695G.040 have the meanings ascribed to them in

those sections.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)

      NAC 695G.020  “Commissioner” defined. (NRS 679B.130)  “Commissioner”

means the Commissioner of Insurance.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)

      NAC 695G.030  “Division” defined. (NRS 679B.130)  “Division”

means the Division of Insurance of the Department of Business and Industry.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)

      NAC 695G.040  “Managed care organization” defined. (NRS 679B.130)  “Managed

care organization” has the meaning ascribed to it in NRS 695G.050.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99)

SYSTEM FOR RESOLVING COMPLAINTS OF INSUREDS

      NAC 695G.100  Requirements for approval. (NRS 679B.130, 695G.200)  To

obtain approval of a system for resolving complaints of insureds from the

Commissioner as required pursuant to NRS 695G.200, a managed care

organization must:

     1.  Demonstrate that the system will include

the external review of a final adverse determination.

     2.  Submit to the Division:

     (a) The name and title of the employee responsible

for the system;

     (b) A description of the procedure used to notify

an insured of the decision regarding his complaint; and

     (c) A copy of the explanation of rights and

procedures which is to be provided to insureds pursuant to NRS 695G.230.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99;

A by R132-03, 4-16-2004)

      NAC 695G.110  Annual report. (NRS 679B.130, 695G.220)

     1.  A managed care organization shall submit

its annual report regarding its system for resolving complaints as required

pursuant to NRS 695G.220 on or

before June 1 of each year. The managed care organization shall retain a copy

of the annual report for at least 3 years or until the next examination

conducted by the Division, whichever is longer.

     2.  The managed care organization is not

required to include in the annual report information concerning an oral inquiry

by an insured relating to a misunderstanding or miscommunication if the

misunderstanding or miscommunication was resolved within 1 working day after

the inquiry was made. If the misunderstanding or miscommunication was not

resolved within 1 working day, the managed care organization shall report it as

a complaint in the annual report.

     (Added to NAC by Comm’r of Insurance by R132-98, eff. 3-30-99;

A by R008-02, 5-23-2002)
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