Nev. Admin. Code § 616C.027 - Review of reduction, denial or nonpayment of bill; appeal of determination upon review
Current through August 4, 2021
NRS 616A.400, 616C.135, 616C.260
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NAC 616C.027 Review of reduction, denial or nonpayment of bill; appeal of determination upon review. (NRS 616A.400, 616C.135, 616C.260)
1. A provider of health care whose bill has been denied or reduced or is not paid in a timely manner may, within 60 days after receiving notice of the denial or reduction, or within 60 days after the payment was due, submit a written request to the Workers’ Compensation Section for a review of that action. The request must identify the billed item for which the review is sought and state the ground upon which the request is based. The Workers’ Compensation Section shall review the matter, and if it determines that issuing a written determination is appropriate, it shall issue a written determination and mail or deliver copies of the determination to the provider of health care and the insurer. If the determination is in the provider’s favor, the insurer shall, within 30 days after receiving notice of the determination, pay the bill, unless an appeal is taken in the manner provided by subsection 2.
2. A provider of health care or insurer aggrieved by the determination of the Workers’ Compensation Section may file a request for a hearing before an appeals officer. The request must be filed within 30 days after the date of the determination.
3. The provider of health care and the insurer will be the only parties to the hearing scheduled pursuant to subsection 2.
[Industrial Comm’n, No. 25.040, eff. 7-1-73; A 6-24-76; renumbered as 15.040, 6-30-82] — (NAC A by Dep’t of Industrial Relations, 10-26-83; A by Div. of Industrial Insurance Regulation, 8-30-91; A by Div. of Industrial Relations by R006-97, 12-9-97; R090-99, 10-28-99; R105-00, 1-18-2001, eff. 3-1-2001; R118-02, 9-7-2005; R108-09, 6-30-2010)