Nev. Admin. Code § 695D.510 - Requirements for approval
To obtain approval of a system for resolving complaints of members concerning services covered by an organization from the Commissioner as required pursuant to NAC 695D.500, an organization must:
1. Demonstrate that the system will resolve oral and written complaints concerning:
(a) Payment or reimbursement for covered services;
(b) The availability, delivery or quality of covered services, including, without limitation, adverse determinations made pursuant to utilization review; and
(c) The terms and conditions of the policies of a member.
2. Submit to the Division:
(a) The name and title of the employee responsible for the system;
(b) A description of the procedure used to notify a member of the decision regarding his or her complaint; and
(c) A copy of the explanation of rights and procedures which is to be provided to members pursuant to NAC 695D.520.
NRS 679B.130, 695D.100
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