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.
(Added to NRS by 2003, 782; A 2011, 3415)
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.