1. Each managed care organization shall submit to the Commissioner an annual report regarding its system for resolving complaints established pursuant to NRS 695G.200 on a form prescribed by the Commissioner which includes, without limitation:
(a) A description of the procedures used for resolving complaints of an insured;
(b) The total number of complaints and appeals handled through the system for resolving complaints since the last report and a compilation of the causes underlying the complaints filed;
(c) The current status of each complaint and appeal filed; and
(d) The average amount of time that was needed to resolve a complaint and an appeal, if any.
2. Each managed care organization shall maintain records of complaints filed with it which concern something other than health care services and shall submit to the Commissioner a report summarizing such complaints at such times and in such format as the Commissioner may require.
(Added to NRS by 1997, 306; A 2013, 3655; 2017, 2402)
Structure Nevada Revised Statutes
NRS 695G.012 - "Adverse determination" defined.
NRS 695G.014 - "Authorized representative" defined.
NRS 695G.015 - "Benefits" defined.
NRS 695G.016 - "Clinical peer" defined.
NRS 695G.017 - "Covered person" defined.
NRS 695G.019 - "Health benefit plan" defined.
NRS 695G.020 - "Health care plan" defined.
NRS 695G.022 - "Health care services" defined.
NRS 695G.024 - "Health carrier" defined.
NRS 695G.026 - "Independent review organization" defined.
NRS 695G.030 - "Insured" defined.
NRS 695G.040 - "Managed care" defined.
NRS 695G.050 - "Managed care organization" defined.
NRS 695G.053 - "Medical or scientific evidence" defined.
NRS 695G.055 - "Medically necessary" defined.
NRS 695G.060 - "Primary care physician" defined.
NRS 695G.070 - "Provider of health care" defined.
NRS 695G.080 - "Utilization review" defined.
NRS 695G.085 - "Utilization review organization" defined.
NRS 695G.090 - Applicability of chapter and other provisions.
NRS 695G.100 - Documents filed with Commissioner treated as public record; exception.
NRS 695G.110 - Medical director required to be physician licensed in this State.
NRS 695G.125 - Contracts with certain federally qualified health centers.
NRS 695G.140 - Certain persons in managed care organization in fiduciary relationship to insured.
NRS 695G.150 - Authorization of recommended and covered health care services required.
NRS 695G.190 - Quality improvement committee: Administration; duties.
NRS 695G.210 - Review board; appeal; right to expedited review of complaint; notice to insured.
NRS 695G.245 - Written notice of right to request external review; form; contents.
NRS 695G.247 - Requests for external review to be in writing; exception; form and content.
NRS 695G.271 - Expedited approval or denial of request.
NRS 695G.280 - Basis for decision of independent review organization.
NRS 695G.300 - Submission of complaint of covered person to independent review organization.