{"data":{"id":"us-nv/nrs-695g.012","jurisdiction":"us-nv","citation":"NRS 695G.012","heading":"“Adverse determination” defined.","body":"“Adverse determination” means a determination by a health carrier or utilization review organization that an admission, availability of care, continued stay or other health care service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier’s requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service or payment for the service is therefore denied, reduced or terminated.","path":["TITLE 57 — INSURANCE","CHAPTER 695G - MANAGED CARE","GENERAL PROVISIONS"],"source_url":"https://www.leg.state.nv.us/NRS/NRS-695G.html#NRS695GSec012","current_through":"2025 session (NRS as revised 2026-08-25)","vintage":"","retrieved_at":"2026-09-03T05:51:46Z","sha256":"037aa819c443a4ec016d927749b47c4b6e73de0b330800ffa271ce9e29cd8772","source_id":"us-nv","stale":true,"prev":"us-nv/nrs-695g.010","next":"us-nv/nrs-695g.014"},"notice":"GroundRules: Original legal text. Not legal advice."}