Nev. Admin. Code § 439B.Sec. 18 - NEW
1. Except as otherwise provided in subsection
2, a data submitter that submits historical data relating to covered medical
services, dental services or pharmacy services shall include information on all
service lines for every claim paid or encounter processed during the reporting
period for which the historical data is submitted, regardless of the location
where the service was provided.
2.
Except as otherwise provided in this subsection, a data submitter is not
required to submit historical data pursuant to subsection 1 for a claim which
is denied in its entirety. A data submitter shall submit historical data for a
claim which was paid and reported to the allpayer claims database but is
subsequently reversed or denied.
3.
Files submitted to the all-payer claims database that contain historical data
relating to providers of health care must include demographic data and other
relevant data relating to each provider of health care who is referenced in
historical data described in subsection 1 or 4, including, without limitation:
(a) Primary care providers;
(b) Rendering providers;
(c) Billing providers;
(d) Referring providers;
(e) Attending providers;
(f) Prescribing providers; and
(g) Pharmacies.
4. Files containing historical data relating
to the eligibility for coverage and demographics of covered persons must
include data for each covered person who resided in this State and was eligible
for a defined set of benefits for 1 or more days within the reporting period.
If a covered person is covered by more than one distinct policy, a record must
be included for each policy. If the reporting period of the file spans multiple
months, the covered person must be reported with one record per month of
eligibility.
5. As used in this
section, "encounter" means a covered service or group of services delivered by
a provider to a covered person during a visit or as a result of a visit between
the covered person and the provider.
Notes
NRS 439B.875
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