Health carrier required to notify participating provider of health care of administrative policies and programs of carrier; health carrier required to provide participating provider of health care and covered person explanation of process for paying claims submitted by participating provider of health care; exemptions.
Nev. Rev. Stat. § 687B.730
in effect1. A health carrier which offers or issues a network plan shall:
(a) Notify each participating provider of health care in the network of the responsibilities of the participating provider of health care with respect to any applicable administrative policies and programs of the health carrier including, without limitation, any applicable administrative policies and programs concerning:
(1) Terms of payment;
(2) Utilization review;
(3) Quality assessment and improvement;
(4) Credentialing;
(5) Procedures for grievances and appeals;
(6) Requirements for data reporting;
(7) Requirements for timely notice to the health carrier of changes in the practices of the participating provider of health care, such as discontinuance of accepting new patients;
(8) Requirements for confidentiality; and
(9) Any applicable federal or state programs.
(b) Provide to each participating provider of health care in the network and each covered person at least annually a detailed explanation of the process by which the health carrier will pay claims submitted by participating providers of health care, including, without limitation, the contact information for the department of the health carrier that is responsible for reviewing claims that have been denied in accordance with the process established pursuant to NRS 687B.820 .
2. The provisions of this section do not apply to the provision of health care services by a managed care organization to:
(a) Recipients of Medicaid under the State Plan for Medicaid or insurance pursuant to the Childrens Health Insurance Program pursuant to a contract with the Nevada Health Authority; or
(b) Members of the Public Employees Benefits Program.
3. As used in this section, managed care organization has the meaning ascribed to it in NRS 695G.050 .
Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-687B.htmlFetched: 10/4/2026