Section 439B.Sec. 2.1 - NEW1. To request a list of randomly selected arbitrators pursuant to subsection 3 of NRS 439B.754 to arbitrate a dispute over a claim of less than $5,000, an out-of-network provider must submit a request to the Department. If the out-of-network provider submits the request because the third party has refused or failed to pay the additional amount requested by the out-of-network-provider pursuant to subsection 2 of NRS 439B.754, the out-of-network provider must submit the request by: (a) If the third party refused to pay the additional amount, not later than 30 business days after the date on which the third party notifies the out-of-network provider of the refusal.(b) If the third party failed to pay the additional amount for 30 business days after receiving a request for the additional amount, not later than 30 business days after that date.2. A request submitted pursuant to subsection 1 must be in the form prescribed by the Department and include, without limitation:(a) The date on which the medically necessary emergency services to which the complaint pertains were provided and the type of medically necessary emergency services provided;(b) The contact information for and location of the out-of-network provider that provided the medically necessary emergency services;(c) The type and specialty of each health care practitioner who provided the medically necessary emergency services;(d) The type of third party that provides coverage for the covered person to whom the medically necessary emergency services were rendered and contact information for that third party; and(e) Documentation of:(1) The date on which the out-of-network provider received payment from the third party pursuant to subsection 2 of NRS 439B.748 or paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable, and the amount of payment received;(2) The date on which the out-of-network provider requested additional payment from the third party pursuant to subsection 2 of NRS 439B.754, and the additional amount requested; and(3) The date on which the third party refused to pay the additional amount, if applicable.3. If the Department does not receive a request pursuant to subsection 1 within the prescribed time, the out-of-network provider shall be deemed to have accepted the payment received from the third party pursuant to subsection 2 of NRS 439B.748 or paragraph (c) of subsection 1 or subsection 2 of NRS 439B.751, as applicable, as payment in full for the medically necessary emergency services.4. Not later than 10 business days after receiving a request pursuant to subsection 1, the Department shall notify the out-of-network provider in writing of the receipt of the request. Not later than 20 business days after providing such notification, the Department shall: (a) Review the request and verify the information contained therein; and(b) Notify the out-of-network provider in writing of any additional information necessary to complete or clarify the request.5. The Department will approve a request submitted pursuant to subsection 1 not later than 5 business days after determining that the request includes the documentation required by subsection 2 and is otherwise complete and clear. Not later than 5 business days after approving a request, the Department shall: (a) Notify the out-of-network provider and the third party in writing of the approval.(b) Randomly select five employees of the Office for Consumer Health Assistance of the Department who are qualified to arbitrate the dispute and ensure that those arbitrators do not have a conflict of interest that would prevent the arbitrator from impartially rendering a decision. For the purposes of this paragraph, a conflict of interest shall be deemed to exist if the arbitrator, or any person affiliated with the arbitrator:(1) Has direct involvement in the licensing, certification or accreditation of a health care facility, insurer or provider of health care;(2) Has a direct ownership interest or investment interest in a health care facility, insurer or provider of health care;(3) Is employed by, or participating in, the management of a health care facility, insurer or provider of health care; or(4) Receives or has the right to receive, directly or indirectly, remuneration pursuant to any arrangement for compensation with a health care facility, insurer or provider of health care.(c) Provide to the out-of-network provider and the third party a written list of five arbitrators selected pursuant to paragraph (b) who have been determined not to have a conflict of interest.Nev. Admin. Code § 439B.Sec. 2.1
Added to NAC by Dept of Human Resources, by R101-19A, eff. 9/19/2022; Added to NAC by Dept of Human Resources, by R101-19A, eff. 9/19/2022