695G.261 - Review of documents by external review organization; decision of external review organization. - Nevada Statutes

695G.261  Review of documents by external review organization; decision of external review organization.

      1.  Except as otherwise provided in NRS 695G.271, upon receipt of a request for an external review pursuant to NRS 695G.251, the external review organization shall, within 5 days after receiving the request:

      (a) Review the request and the documents and materials submitted pursuant to NRS 695G.251; and

      (b) Notify the insured, the physician of the insured and the managed care organization if any additional information is required to conduct a review of the final adverse determination.

      2.  Except as otherwise provided in NRS 695G.271, the external review organization shall approve, modify or reverse the final adverse determination within 15 days after it receives the information required to make that determination pursuant to this section. The external review organization shall submit a copy of its determination, including the reasons therefor, to:

      (a) The insured;

      (b) The physician of the insured;

      (c) The authorized representative of the insured, if any; and

      (d) The managed care organization.

      (Added to NRS by 2003, 781)