NRS 695F.225: Requirements for notice of denial of claim.

1. If a prepaid limited health service organization denies a claim, the prepaid limited health service organization shall notify the claimant in writing of the denial within:

(a) Twenty-one days after the prepaid limited health service organization receives all information necessary to make a determination concerning the claim, if the information is submitted electronically; or

(b) Thirty days after the prepaid limited health organization receives all information necessary to make a determination concerning the claim, if the information is not submitted electronically.

2. The notice required pursuant to subsection 1 must include, without limitation:

(a) All reasons for denying the claim, including, without limitation, the specific facts and provisions of the evidence of coverage relied upon by the prepaid limited health service organization as a basis to deny the claim;

(b) The criteria by which the prepaid limited health service organization determines whether to approve or deny the claim and a description of the manner in which the prepaid limited health service organization applied those criteria to the claim; and

(c) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim.