Nev. Admin. Code § 686A.288 - Forms for submission of claims

1. The payer of a claim under a contract for health insurance:
(a) Shall accept a claim submitted on a form that:
(1) Has been approved by the Commissioner for the filing of a claim under a contract for health insurance; and
(2) Contains the information necessary to constitute a clean claim.
(b) Shall not require the completion of any other form for the purpose of processing the claim.
2. For the purposes of this section, a "form that has been approved by the Commissioner" means:
(a) For claims submitted by a hospital or other institutional provider, Centers for Medicare and Medicaid Services Form CMS-1450, which is commonly referred to as UB-04, or its successor form;
(b) For claims submitted by a health care practitioner or other person entitled to reimbursement, Centers for Medicare and Medicaid Services Form CMS-1500, or its successor form ; and
(c) For claims submitted by a dentist or other person entitled to reimbursement, American Dental Association Form J430D, or its successor form, or another form approved by the Commissioner for that purpose, which has been completed using the Code on Dental Procedures and Nomenclature set forth in the CDT 2016: Dental Procedure Codes, as adopted by reference in this section.
3. Form CMS-1450, also known as the UB-04 claim form, published by the National Uniform Billing Committee, is available from Briggs Healthcare on the Internet at http://www.briggscorp.com , at the price of $20.40. Copies of the form may also be available through office supply stores.
4. Form CMS-1500, published by the National Uniform Claim Committee, is available from the United States Government Printing Office on the Internet website https://bookstore.gpo.gov/ , or by mail at P.O. Box 979050, St. Louis, Missouri 63197-9000, at the price of $32. Copies of the form may also be available through local printing companies and office supply stores.
5. Form ADA-J430D, published by the American Dental Association, is available from the American Dental Association on the Internet website http://www.adacatalog.org , at the price of $19.95 for members and $29.95 for nonmembers.
6. For purposes of this section, the CDT 2016: Dental Procedure Codes, published by the American Dental Association, is hereby adopted by reference. A copy of the publication may be obtained from the American Dental Association on the Internet website http://www.adacatalog.org , at the price of $39.95 for members and $59.95 for nonmembers.

Notes

Nev. Admin. Code § 686A.288
Added to NAC by Comm'r of Insurance by R175-01, eff. 5-23-2002; A by R026-12, 9-14-2012; A by R119-16A, eff. 12/21/2016
NRS 679B.130, 679B.138, 686A.015

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