{"data":{"id":"us-nv/nrs-695f.225","jurisdiction":"us-nv","citation":"NRS 695F.225","heading":"Requirements for notice of denial of claim.","body":"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:\n(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\n(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.\n2. The notice required pursuant to subsection 1 must include, without limitation:\n(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;\n(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\n(c) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim.","path":["TITLE 57 — INSURANCE","CHAPTER 695F - PREPAID LIMITED HEALTH SERVICE ORGANIZATIONS","OPERATION"],"source_url":"https://www.leg.state.nv.us/NRS/NRS-695F.html#NRS695FSec225","current_through":"2025 session (NRS as revised 2026-08-25)","vintage":"","retrieved_at":"2026-09-03T05:51:46Z","sha256":"f4dac2c73a6765174d58618f8709bd32810ab742b2664f3ad301ae93c35e7c37","source_id":"us-nv","stale":true,"prev":"us-nv/nrs-695f.220","next":"us-nv/nrs-695f.230"},"notice":"GroundRules: Original legal text. Not legal advice."}