NRS 687B.820: Procedures for resolution of disputes; exemptions.

1. A health carrier which offers or issues a network plan shall establish procedures for the resolution of administrative, payment or other disputes between a participating provider of health care in the network and the health carrier. Those procedures must include, without limitation, an efficient process by which a participating provider of health care may challenge the denial of a claim by the health carrier. The process must allow for the clear resolution of each challenge within a reasonable time.

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 Children’s 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.