State Law

Nevada Rev. Statutes-Title 57-Chapter 695G. Managed Care-Coverage by Managed Care Organizations

07/13/2020 Nevada Section 695G.160

Written criteria concerning coverage of health care services and standards for quality of health care services

U.R. Criteria

1. Each managed care organization shall establish written criteria:

(a) Setting forth the manner in which it determines whether to authorize coverage of a health care service; and

(b) Setting forth its method for reviewing standards for the quality of health care services provided to an insured.

2. Such written criteria must be:

(a) Developed with the assistance of practicing providers of health care;

(b) Developed using generally recognized and, if appropriate, specialized clinical principles and processes;

(c) Reviewed at least one time each year and, if appropriate, updated; and

(d) Made available to an insured for review upon request of the insured any time that the managed care organization denies coverage of a specific health care service to the insured.