Title 57

NRS 687B.607 “Direct notification” defined. “Direct notification” means a written or electronic communication from a health carrier to a provider of health care documenting third-party access to a network. (Added to NRS by 2019, 1602)

NRS 687B.610 “Evidence of coverage” defined. “Evidence of coverage” means any certificate, agreement or contract issued to a covered person by a health carrier setting forth the coverage to which the covered person is entitled pursuant to a network plan. (Added to NRS by 2017, 23…

NRS 687B.615 “Health benefit plan” defined. “Health benefit plan” has the meaning ascribed to it in NRS 695G.019. (Added to NRS by 2017, 2349)

NRS 687B.620 “Health care services” defined. “Health care services” has the meaning ascribed to it in NRS 695G.022. (Added to NRS by 2017, 2349)

NRS 687B.625 “Health carrier” defined. “Health carrier” has the meaning ascribed to it in NRS 695G.024. (Added to NRS by 2017, 2349)

NRS 687B.630 “Intermediary” defined. “Intermediary” means a person authorized to negotiate and execute a contract between a provider of health care and a health carrier entered into for the purposes of a network plan, whether the person acts on behalf of the provider of health ca…

NRS 687B.635 “Medically necessary” defined. “Medically necessary” has the meaning ascribed to it in NRS 695G.055. (Added to NRS by 2017, 2349)

NRS 687B.640 “Network” defined. “Network” means a defined set of providers of health care who are under contract with a health carrier to provide health care services pursuant to a network plan offered or issued by the health carrier. (Added to NRS by 2017, 2349)

NRS 687B.645 “Network plan” defined. “Network plan” means a health benefit plan offered or issued by a health carrier under which the financing and delivery of health care services, including, without limitation, items and services paid for as health care services, are provided, …

NRS 687B.650 “Participating provider of health care” defined. “Participating provider of health care” means a provider of health care who, under a contract with a health carrier, has agreed to provide health care services to covered persons pursuant to a network plan with an expe…

NRS 687B.655 “Primary care physician” defined. “Primary care physician” has the meaning ascribed to it in NRS 695G.060. (Added to NRS by 2017, 2350)

NRS 687B.658 “Provider network contract” defined. “Provider network contract” means a contract between a health carrier and a provider of health care specifying the rights and responsibilities of the health carrier and the provider of health care for delivery of health care servi…

NRS 687B.660 “Provider of health care” defined. “Provider of health care” has the meaning ascribed to it in NRS 695G.070. (Added to NRS by 2017, 2350)

NRS 687B.664 “Third party” defined. “Third party” means an organization that enters into a contract with a health carrier or with another third party to gain access to a provider network contract. (Added to NRS by 2019, 1602)

NRS 687B.665 “Utilization review” defined. “Utilization review” has the meaning ascribed to it in NRS 695G.080. (Added to NRS by 2017, 2350)

NRS 687B.670 Requirements to offer or issue network plan. If a health carrier offers or issues a network plan, the health carrier shall, with regard to that network plan: 1. Comply with all applicable requirements set forth in NRS 687B.600 to 687B.850, inclusive; 2. As applicable…

NRS 687B.675 Provision of information to Office for Consumer Health Assistance. 1. A health carrier which offers or issues a network plan shall: (a) Provide to the Office for Consumer Health Assistance at least annually the telephone number and electronic mail address of a naviga…

NRS 687B.680 Health carrier required to establish mechanism for ongoing notification of participating providers of health care of services covered by network plan and for which provider is responsible. A health carrier which offers or issues a network plan shall, with regard to t…

NRS 687B.690 Required provisions in contract between participating provider of health care and health carrier. Each contract entered into for the purposes of a network plan between a participating provider of health care and the health carrier must include, without limitation, a …

NRS 687B.692 Provider network contract: Circumstances in which health carrier prohibited from denying request to enter into contract from a provider of health care employed or accepting employment with medical school; grounds for denial of request or termination of contract. 1. A…

NRS 687B.693 Access to services and contractual discounts of a provider of health care: Inapplicability of provisions. NRS 687B.693 to 687B.697, inclusive, do not apply: 1. To provider network contracts for health care services provided to covered persons under Medicare or the St…

NRS 687B.694 Access to services and contractual discounts of a provider of health care: Requirements for granting access; termination; confidentiality. 1. A health carrier shall not grant access to services and contractual discounts of a provider of health care pursuant to a prov…

NRS 687B.695 Access to services and contractual discounts of a provider of health care: Obligations of third party that grants access to another third party. 1. A third party, having itself been granted access to services and contractual discounts of a provider of health care pur…

NRS 687B.696 Access to services and contractual discounts of a provider of health care: Information required to be provided to health carrier and providers of health care by third parties; update of information. 1. A third party shall inform the health carrier and providers of he…

NRS 687B.697 Access to services and contractual discounts of a provider of health care: Obligations of health carrier and third parties concerning remittance advice or explanation of payment; refusal of discount taken on such advice or explanation by provider of health care; corr…

NRS 687B.700 Contract required to provide requirement that participating provider of health care continue delivery of services if health carrier or intermediary insolvent or ceases operations for specified period; billing of covered person. Each contract entered into for the purp…

NRS 687B.710 Certain provisions included in contract required to be construed in favor of covered person, survive termination of contract and supersede certain contrary agreements. The provisions included in a contract to comply with the requirements set forth in NRS 687B.690 and…

NRS 687B.720 Contract required to provide for notice of insolvency or cessation of operations of health carrier or intermediary to participating provider of health care. Each contract entered into for the purposes of a network plan between a participating provider of health care …

NRS 687B.723 Claim for dental care: Health carrier or administrator of health benefit plan prohibited from denying claim for which prior authorization has been granted; exceptions. 1. A health carrier which provides dental coverage or an administrator of a health benefit plan tha…

NRS 687B.725 Claim for dental care: Requirements and limitations related to recovery of overpayments. 1. A health carrier which provides dental coverage or any administrator of a health benefit plan that includes dental coverage who recovers overpayments shall provide written not…

NRS 687B.730 Health carrier required to notify participating provider of health care of administrative policies and programs of carrier; health carrier required to provide participating provider of health care and covered person explanation of process for paying claims submitted …

NRS 687B.740 Inducement to provide less than medically necessary health care services prohibited. A health carrier which offers or issues a network plan shall not offer an inducement to a participating provider of health care in the network that would encourage or otherwise incen…

NRS 687B.750 Health carrier not to prohibit certain actions by participating provider of health care. A health carrier which offers or issues a network plan shall not prohibit a participating provider of health care in the network from: 1. Discussing any specific treatment option…

NRS 687B.760 Health records; confidentiality. Each contract entered into for the purposes of a network plan between a participating provider of health care and the health carrier must require the participating provider of health care to make health records available to appropriat…

NRS 687B.770 Assignment or delegation of rights and responsibilities without prior written consent prohibited. Each contract entered into for the purposes of a network plan between a participating provider of health care and the health carrier must prohibit the health carrier and…

NRS 687B.780 Health carrier required to ensure that participating providers of health care furnish covered services to all covered persons; exception. 1. A health carrier which offers or issues a network plan shall ensure that participating providers of health care in the network…

NRS 687B.790 Health carrier required to notify participating providers of health care of obligation to collect coinsurance, copayment or deductible or notify covered person of obligation for services not covered. A health carrier which offers or issues a network plan shall notify…

NRS 687B.795 Health carrier required to demonstrate capacity to adequately deliver family planning services provided by pharmacists or pharmacies; notice to covered persons; regulations. 1. A health carrier which offers or issues a network plan: (a) Must demonstrate the capacity …

NRS 687B.800 Retaliation for good faith reporting to state or federal authority prohibited. A health carrier which offers or issues a network plan shall not penalize a participating provider of health care in the network because the participating provider of health care, in good …

NRS 687B.805 Prohibited acts by health carrier relating to 340B Program; provisions do not prohibit certain entities from taking actions necessary to prevent duplicate discounts or rebates or ensure financial stability of Medicaid program. 1. A health carrier shall not: (a) Discr…

NRS 687B.810 Health carrier required to establish mechanism to allow participating provider of health care to determine whether a person is a covered person or within grace period for payment of premium. A health carrier which offers or issues a network plan shall establish a mec…

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 …

NRS 687B.830 Contract for purposes of network plan prohibited from conflicting with network plan or law; notice of provisions and incorporated documents; notice of changes. 1. A contract entered into for the purposes of a network plan between a participating provider of health ca…

NRS 687B.840 Health carrier required to inform participating provider of health care of status and inclusion on certain lists maintained by health carrier upon request or change in such status or inclusion. A health carrier which offers or issues a network plan shall inform a par…

NRS 687B.850 Regulations. The Commissioner may adopt any regulations necessary to carry out the purposes and provisions of NRS 687B.600 to 687B.850, inclusive. (Added to NRS by 2017, 2354) STOP-LOSS INSURANCE