t of interest; request for additional information; compliance with requirements. 1. Except as otherwise provided in this section, an insurer shall approve or deny a bill for accident benefits received from a provider of health care within 30 calendar days after the insurer receives the bill. If the bill for accident benefits is approved, the insurer shall pay the bill within 30 calendar days after it is approved. Except as otherwise provided in this section, if the approved bill for accident benefits is not paid within that period, the insurer shall pay interest to the provider of health care at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions, on January 1 or July 1, as the case may be, immediately preceding the date on which the payment was due, plus 6 percent. The interest must be calculated from 30 calendar days after the date on which the bill is approved until the date on which the bill is paid. 2. If an insurer needs additional information to determine whether to approve or deny a bill for accident benefits received from a provider of health care, he shall notify the provider of health care of his request for the additional information within 20 calendar days after he receives the bill. The insurer shall notify the provider of health care of all the specific reasons for the delay in approving or denying the bill for accident benefits. Upon the receipt of such a request, the provider of health care shall furnish the additional information to the insurer within 20 calendar days after receiving the request. If the provider of health care fails to furnish the additional information within that period, the provider of health care is not entitled to the payment of interest to which he would otherwise be entitled for the late payment of the bill for accident benefits. The insurer shall approve or deny the bill for accident benefits within 20 calendar days after he receives the additional information. If the bill for accident benefits is approved, the insurer shall pay the bill within 20 calendar days after he receives the additional information. Except as otherwise provided in this subsection, if the approved bill for accident benefits is not paid within that period, the insurer shall pay interest to the provider of health care at the rate set forth in subsection 1. The interest must be calculated from 20 calendar days after the date on which the insurer receives the additional information until the date on which the bill is paid. 3. An insurer shall not request a provider of health care to resubmit information that the provider of health care has previously provided to the insurer, unless the insurer provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the accident benefits, harass the provider of health care or discourage the filing of claims. 4. An insurer shall not pay only a portion of a bill for accident benefits that has been approved and is fully payable. 5. The Administrator may require an insurer to provide evidence which demonstrates that the insurer has substantially complied with the requirements of this section, including, without limitation, payment within the time required of at least 95 percent of approved accident benefits or at least 90 percent of the total dollar amount of approved accident benefits. If the Administrator determines that an insurer is not in substantial compliance with the requirements of this section, the Administrator may require the insurer to pay an administrative fine in an amount to be determined by the Administrator. 6. The payment of interest provided for in this section for the late payment of an approved claim may be waived only if the payment was delayed because of an act of God or another cause beyond the control of the insurer. 7. Payments made by an insurer pursuant to this section are not an admission of liability for the accident benefits or any portion of the accident benefits. (Added to NRS by 2001, 2736) NRS 616C.137 Denial of payment for unrelated services: Requirements for notification; liability of injured employee; appeal. 1. If an insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 denies payment for some or all of the services itemized on a statement submitted by a provider of health care on the sole basis that those services were not related to the employee’s industrial injury or occupational disease, the insurer, organization for managed care or employer shall, at the same time that it sends notification to the provider of health care of the denial, send a copy of the statement to the injured employee and notify the injured employee that it has denied payment. The notification sent to the injured employee must: (a) State the relevant amount requested as payment in the statement, that the reason for denying payment is that the services were not related to the industrial injury or occupational disease and that, pursuant to subsection 2, the injured employee will be responsible for payment of the relevant amount if he does not, in a timely manner, appeal the denial pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, or appeals but is not successful. (b) Include an explanation of the injured employee’s right to request a hearing to appeal the denial pursuant to NRS 616C.305 and 616C.315 to 616C.385, inclusive, and a suitable form for requesting a hearing to appeal the denial. 2. An injured employee who does not, in a timely manner, appeal the denial of payment for the services rendered or who appeals the denial but is not successful is responsible for payment of the relevant charges on the itemized statement. 3. To succeed on appeal, the injured employee must show that the: (a) Services provided were related to the employee’s industrial injury or occupational disease; or (b) Insurer, organization for managed care or employer who provides accident benefits for injured employees pursuant to NRS 616C.265 gave prior authorization for the services rendered and did not withdraw that prior authorization before the services of the provider of health care were rendered. (Added to NRS by 2001, 2737) NRS 616C.138 Payment of provider of health care upon insurer’s denial of authorization or responsibility for treatment or other services provided; reimbursement of injured employee or health or casualty insurer; recovery of excess amount paid to provider of health care. 1. Except as otherwise provided in this section, if a provider of health care provides treatment or other services that an injured employee alleges are related to an industrial injury or occupational disease and an insurer, an organization for managed care, a third-party administrator or an employer who provides accident benefits for injured employees pursuant to NRS 616C.265 denies authorization or responsibility for payment for the treatment or other services, the provider of health care is entitled to be paid for the treatment or other services as follows: (a) If the treatment or other services will be paid by a health insurer which has a contract with the provider of health care under a health benefit plan that covers the injured employee, the provider of health care is entitled to be paid the amount that is allowed for the treatment or other services under that contract. (b) If the treatment or other services will be paid by a health insurer which does not have a contract with the provider of health care as set forth in paragraph (a) or by a casualty insurer or the injured employee, the provider of health care is entitled to be paid not more than: (1) The amount which is allowed for the treatment or other services set forth in the schedule of fees and charges established pursuant to NRS 616C.260; or (2) If the insurer which denied authorization or responsibility for the

Vegas Law