Nevada Administrative Code

NAC 616C.080 Duties of physician, chiropractic physician or medical facility required to file claim. (NRS 616A.400, 616C.040) 1. A physician or chiropractic physician who is required to file a claim for compensation pursuant to NRS 616C.040, or a medical facility that has been de…

NAC 616C.082 Contents, maintenance and ownership of claims and documents concerning claims. (NRS 616A.400) 1. An insurer, third-party administrator or organization for managed care shall ensure that the date of receipt of all documents concerning claims that it receives pursuant …

NAC 616C.088 Files of claims: Contents; retention. (NRS 616A.400, 616D.330) 1. Each file of a claim concerning an industrial injury or occupational disease that is maintained by an insurer or third-party administrator must contain: (a) The employer’s report of the industrial inju…

NAC 616C.091 Notice of determination to accept or deny claim. (NRS 616A.400, 616C.065) 1. After receipt of a claim for compensation, the insurer or third-party administrator shall give written notice of its determination to accept or deny the claim to the injured employee, the at…

NAC 616C.092 Determination of unreasonable delay or refusal to pay claim. (NRS 616A.400, 616C.065) To determine whether an insurer has unreasonably delayed or refused to pay a claim for compensation for the purposes of subsection 4 of NRS 616C.065, the Administrator will consider…

NAC 616C.094 Notification of determination concerning request relating to claim; right to appeal determination. (NRS 616A.400, 616C.065, 616C.235, 616C.390) 1. Except as otherwise provided in this section, within 30 days after receipt of a written request relating to a claim made…

NAC 616C.095 Resubmission of request for determination relating to claim; request for determination not precluded by failure to timely request hearing. (NRS 616A.400) 1. If an insurer fails to respond to a written request for a determination within 30 days after the date on which…

NAC 616C.097 Required statement on written notice of determination explaining process if disagreement with determination. (NRS 616A.400) 1. Any written notice of a determination by an organization for managed care that relates to accident benefits must include at the bottom of th…

NAC 616C.103 Rating evaluation of injured employee: Requirements; award of payment; appeal. (NRS 616A.400, 616C.490) 1. For purposes of determining whether an injured employee is stable and ratable and entitled to an evaluation to determine the extent of any permanent impairment …

NAC 616C.105 Rating evaluation of injured employee: Payment for cost of travel. (NRS 616A.400, 616C.490) 1. An insurer who requests that an injured employee submit to a rating evaluation pursuant to NRS 616C.490 shall include with the notice required pursuant to subsection 3 of N…

NAC 616C.109 Presence of representative during rating evaluation. (NRS 616A.400, 616C.490) 1. If an injured employee, employer, insurer or third-party administrator is permitted by the rating physician or chiropractic physician to have his or her attorney or other representative …

NAC 616C.112 Notice of intention to close claim. (NRS 616A.400, 616C.235) The notice of intention to close a claim required by subsection 1 of NRS 616C.235 must include: 1. The provisions of subsection 2 of NRS 616C.390; and 2. An offer to the injured employee of an opportunity t…

NAC 616C.115 Expenses of investigation. (NRS 616A.400) The insurer shall pay all the expenses of any investigation, including, without limitation, the cost of travel and medical examinations, authorized by it to obtain a full and complete record of the cause, scope and origin of …

NAC 616C.1156 Claim received for employer to whom insurer does not provide coverage: Copy of claim to Administrator. (NRS 616A.400, 616A.417) If an insurer receives a claim for compensation from an injured employee and determines that the employer named in the claim for compensat…

NAC 616C.116 Applicability of provisions. (NRS 616A.400) The provisions of NAC 616C.1162 to 616C.1168, inclusive, do not apply to an evaluation performed pursuant to NRS 616C.490. (Added to NAC by Div. of Industrial Relations by R098-98, 12-18-98, eff. 7-1-99)

NAC 616C.1162 Notification by insurer or employer of request for medical examination. (NRS 616A.400, 616C.140) 1. If an insurer or employer requests that an injured employee who has filed a claim for compensation submit to a medical examination pursuant to NRS 616C.140, the insur…

NAC 616C.1164 Provision by insurer or employer of copies of report of medical examination. (NRS 616A.400, 616C.140) 1. An insurer that requests an injured employee to submit to a medical examination pursuant to NRS 616C.140 shall provide a copy of the report of the medical examin…

NAC 616C.1166 Payment of charges. (NRS 616A.400, 616C.135, 616C.140) An insurer or employer that requests an injured employee to submit to a medical examination pursuant to NRS 616C.140 shall: 1. If the medical examination is conducted within this State, pay the charges in the ma…

NAC 616C.1168 Payment for travel costs. (NRS 616A.400, 616C.140) An insurer or employer that requests an injured employee to submit to a medical examination pursuant to NRS 616C.140 shall include with the notification required pursuant to subsection 1 of NAC 616C.1162 payment for…

NAC 616C.117 Definitions. (NRS 616A.400) As used in NAC 616C.117 to 616C.156, inclusive, unless the context otherwise requires, the words and terms defined in NAC 616C.118 and 616C.119 have the meanings ascribed to them in those sections. (Added to NAC by Div. of Industrial Relat…

NAC 616C.118 “Health care records” defined. (NRS 616A.400) “Health care records” means any reports, notes, orders, photographs, X-rays or other recorded data or information which: 1. Is maintained in written, electronic or any other form; 2. Is received or produced by a provider …

NAC 616C.119 “Provider of health care” defined. (NRS 616A.400) “Provider of health care” means any physician, hospital or other person who is licensed or otherwise authorized by this State to furnish any health care service. (Added to NAC by Div. of Industrial Relations by R121-9…

NAC 616C.120 Right of injured employee to inspect or obtain health care records. (NRS 616A.400) The provisions of NAC 616C.123 to 616C.156, inclusive, do not prohibit or otherwise impair or interfere with the right of an injured employee to inspect or obtain his or her health car…

NAC 616C.123 Occupational Medicine Practice Guidelines: Adoption by reference; annual review by Administrator; use as minimum standards; authorization for treatment exceeding minimum standards. (NRS 616A.400, 616C.250) 1. The most recently published edition of or update to the Oc…

NAC 616C.126 Treatment of injured employees in cases of emergency or severe trauma. (NRS 616A.400, 616C.245, 616C.260) 1. The treatment of injured employees in cases of an emergency or severe trauma is not restricted to physicians and chiropractic physicians who: (a) Are members …

NAC 616C.129 Adherence to rules for treatment of injured employees by members of panel of physicians and chiropractic physicians. (NRS 616A.400, 616C.245, 616C.250, 616C.260) The members of the panel of physicians and chiropractic physicians, approved for treatment of employees p…

NAC 616C.138 Billing for provision of certain supplies and services. (NRS 616A.400, 616C.260) Supplies and materials provided by the provider of health care over and above those usually included in a visit to his or her office or in other services rendered must be billed by repor…

NAC 616C.141 Requirements for programs of treatment billed under certain codes; use of codes in billing; contents of bills for certain office visits. (NRS 616A.400, 616C.250, 616C.260) 1. If a program of treatment that is required to be billed under codes 97001 to 97799, inclusiv…

NAC 616C.143 Consultation or treatment provided outside State: Prior written authorization; treatment in cases of emergency. (NRS 616A.400, 616C.250, 616C.260) 1. Except as otherwise provided in this section, an insurer is not financially liable for consultation or treatment that…

NAC 616C.145 Relative Values for Physicians: Adoption by reference; compliance by providers of health care required; annual review by Administrator. (NRS 616A.400, 616C.260) 1. Except as otherwise provided in this section, providers of health care who treat injured employees purs…

NAC 616C.146 Relative Value Guide of the American Society of Anesthesiologists: Adoption by reference; compliance by anesthesiologists required; annual review by Administrator; use of codes. (NRS 616A.400, 616C.260) 1. Anesthesiologists who treat injured employees pursuant to thi…

NAC 616C.147 Adoption by reference of codes for hospital-based outpatient surgery centers and Ambulatory Surgical Center (ASC) payment groups and procedures. (NRS 616A.400, 616C.260) The Division hereby adopts by reference: 1. The list of eligible codes for hospital-based outpati…

NAC 616C.148 Reports of rating evaluation by rating physician or chiropractic physician; mailing; contents; retention of report and documentation. (NRS 616A.400, 616C.490) Unless good cause is shown: 1. A rating physician or chiropractic physician shall mail a report of an evalua…

NAC 616C.149 Contents of bill to insurer; adoption by reference and annual review of ICD-CM codes; submission to insurer of order for services rendered. (NRS 616A.400, 616C.130, 616C.260) 1. Each provider of health care and each medical facility shall submit a bill to the insurer…

NAC 616C.150 Eligibility and computation. (NRS 616A.400, 616C.245, 616C.260, 616C.365) 1. The insurer shall reimburse an injured employee for the cost of transportation to and from the place where the injured employee receives health care if he or she is required to travel 20 mil…

NAC 616C.153 Reimbursement for airfare. (NRS 616A.400, 616C.260) With the prior approval of the insurer, an injured employee may be reimbursed for airfare where the time, distance, convenience or cost justifies the travel by air. [Industrial Comm’n, No. 42 § 5, eff. 6-30-82]—(NAC…

NAC 616C.156 Limitations on reimbursements. (NRS 616A.400, 616C.260) 1. Unless otherwise directed or approved by the insurer or the injured employee’s treating physician or chiropractic physician, an injured employee who chooses to obtain health care services at a more distant pl…

NAC 616C.260 Definitions. (NRS 616C.295, 616C.310) As used in NAC 616C.260 to 616C.336, inclusive, unless the context otherwise requires: 1. “Hearings Division” means the Hearings Division of the Department of Administration. 2. “Licensed representative” means a person who is lic…

NAC 616C.265 Hearing officer: Qualifications regarding education and experience. (NRS 616C.295) A person who wishes to serve as a hearing officer pursuant to chapters 616A to 616D, inclusive, or chapter 617 of NRS must: 1. Possess a bachelor’s degree from an accredited college or…

NAC 616C.267 Hearing officer: Additional qualifications. (NRS 616C.295) 1. In addition to possessing the qualifications required by NAC 616C.265, a hearing officer must: (a) Be able to: (1) Interact effectively with all participants at a hearing in a manner which ensures an impar…

NAC 616C.269 Hearing officer: Training requirements. (NRS 616C.295) 1. To the extent that money is made available to the Hearings Division for the purpose of training hearing officers, a hearing officer must successfully complete annually at least 20 hours of training, which may …

NAC 616C.2691 Hearing or appeals officer: Professional conduct. (NRS 616C.295) A hearing or appeals officer shall: 1. Act in a manner that preserves the integrity, impartiality and independence of hearings in contested cases for compensation conducted pursuant to chapters 616A to…

NAC 616C.2692 Hearing or appeals officer: Prohibited acts. (NRS 616C.295) 1. A hearing or appeals officer shall not: (a) Engage in conduct that reflects adversely on the character, competence or temperament of the officer or on the officer’s fitness to serve, including, without l…

NAC 616C.2693 Limitation on communications between hearing or appeals officer and party or representative; disclosure. (NRS 616C.295) 1. Except as otherwise provided in subsection 2, a hearing or appeals officer shall not engage in any communication or contact with a party to a p…

NAC 616C.2694 “Conflict of interest” and “personal interest” interpreted. (NRS 616C.295) As used in NRS 616C.300 and 616C.340, the Chief of the Hearings Division interprets the terms “conflict of interest” and “personal interest” to include, without limitation: 1. A bias or preju…

NAC 616C.26941 Complaint of violation; investigation. (NRS 616C.295) 1. A complaint alleging that a hearing or appeals officer has violated a provision of NAC 616C.2691 to 616C.2694, inclusive, must be in writing and submitted to the senior appeals officer. 2. The senior appeals …

NAC 616C.26942 Appeals officer: Training requirements. (NRS 616C.295) 1. To the extent that money is made available to the Hearings Division for the purpose of training appeals officers, an appeals officer must successfully complete annually at least 20 hours of training, which m…