Assembly Bill No. 36–Assemblyman Neighbors
Prefiled January 24, 2001
____________
Referred to Committee on Commerce and Labor
SUMMARY—Revises various provisions governing
approval and payment of claims. (BDR 57‑460)
FISCAL NOTE: Effect on Local Government: No.
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EXPLANATION
– Matter in bolded italics is new; matter
between brackets [omitted material] is material to be omitted.
Green numbers along
left margin indicate location on the printed bill (e.g., 5-15 indicates page 5, line 15).
AN ACT relating to insurance; revising various provisions governing the approval and
payment of claims; and providing other matters properly relating thereto.
THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:
1-1 Section 1. NRS 683A.0879
is hereby amended to read as follows:
1-2 683A.0879 1. Except as otherwise provided in subsection 2,
an
1-3 administrator shall approve
or deny a claim , or any part of
the claim that
1-4 can be approved or denied, relating to health insurance coverage within
30
1-5 days after the administrator
receives the claim. If the claim ,
or any part
1-6 thereof, is approved, the administrator shall pay the claim or the part of
1-7 the claim that has been approved within 30 days after [it] the claim or
1-8 part of the claim is approved. If the approved claim or the approved part
1-9 of the claim is not paid within that period, the administrator
shall pay
1-10 interest on the claim or approved part of the claim
at the rate of interest
1-11 established pursuant to NRS
99.040 unless a different rate of interest is
1-12 established pursuant to an
express written contract between the
1-13 administrator and the
provider of health care. The interest must be
1-14 calculated from 30 days
after the date on which the claim
or part of the
1-15 claim is approved until the claim or approved part of the claim is paid.
1-16 2. If the administrator
requires additional information to determine
1-17 whether to approve or deny
the claim, or any part thereof,
he shall notify
1-18 the claimant of his request
for the additional information within 20 days
1-19 after he receives the claim.
The administrator shall notify the provider of
1-20 health care of all the
specific reasons for the delay in approving or denying
1-21 the claim [.] , or part thereof. The
administrator shall approve or deny the
1-22 claim or the part of the claim for which additional information
was
2-1 required within [30] 15 days
after receiving the additional information. If
2-2 the claim or the part of the claim for which
additional information was
2-3 required is approved, the administrator shall pay the claim or the part of
2-4 the claim within [30] 15 days
after he receives the additional information.
2-5 If the approved claim or the approved part of the claim
is not paid within
2-6 that period, the
administrator shall pay interest on the claim or approved
2-7 part of the claim in the manner prescribed in subsection 1 [.] , except that
2-8 the interest must be calculated from 15 days after the date on
which the
2-9 additional information is received until the claim or approved part
of the
2-10 claim is paid.
2-11 3. An administrator shall
not request a claimant to resubmit
2-12 information that the
claimant has already provided to the administrator,
2-13 unless the administrator
provides a legitimate reason for the request and the
2-14 purpose of the request is
not to delay the payment of the claim, harass the
2-15 claimant or discourage the
filing of claims.
2-16 4. An administrator shall
not pay only [part] a
portion of a claim
or
2-17 part thereof that has been approved and is fully payable.
2-18 5. A court shall award
costs and reasonable attorney’s fees to the
2-19 prevailing party in an
action brought pursuant to this section.
2-20 Sec. 2. NRS 689A.410 is hereby amended to read as follows:
2-21 689A.410 1. Except as otherwise provided in subsection 2,
an insurer
2-22 shall approve or deny a
claim , or any part of the claim
that can be
2-23 approved or denied, relating to a policy of health insurance within 30
days
2-24 after the insurer receives
the claim. If the claim , or any
part thereof, is
2-25 approved, the insurer shall
pay the claim or the part of the
claim that has
2-26 been approved within 30 days after [it] the claim or part of the claim is
2-27 approved. If the approved
claim or the approved part of the
claim is not
2-28 paid within that period, the
insurer shall pay interest on the claim or
2-29 approved part of the claim at the rate of interest established pursuant
to
2-30 NRS 99.040 unless a
different rate of interest is established pursuant to an
2-31 express written contract
between the insurer and the provider of health
2-32 care. The interest must be
calculated from 30 days after the date on which
2-33 the claim or part of the claim is
approved until the claim or
approved part
2-34 of the claim is paid.
2-35 2. If the insurer requires
additional information to determine whether
2-36 to approve or deny the
claim, or any part thereof, it
shall notify the
2-37 claimant of its request for
the additional information within 20 days after it
2-38 receives the claim. The
insurer shall notify the provider of health care of all
2-39 the specific reasons for the
delay in approving or denying the claim [.] , or
2-40 part thereof. The insurer shall approve or deny the claim or the part of the
2-41 claim for which additional information was required within [30] 15 days
2-42 after receiving the
additional information. If the claim or the part of the
2-43 claim for which additional information was required is approved, the
2-44 insurer shall pay the claim or the part of the claim
within 30 days after it
2-45 receives the additional
information. If the approved claim or
the approved
2-46 part of the claim is not paid within that period, the insurer shall
pay
2-47 interest on the claim or approved part of the claim in
the manner
2-48 prescribed in subsection 1 [.] , except that the interest must be
calculated
3-1 from 15 days after the date on which the additional information is
3-2 received until the claim or approved part of the claim is paid.
3-3 3. An insurer shall not
request a claimant to resubmit information that
3-4 the claimant has already
provided to the insurer, unless the insurer provides
3-5 a legitimate reason for the
request and the purpose of the request is not to
3-6 delay the payment of the
claim, harass the claimant or discourage the filing
3-7 of claims.
3-8 4. An insurer shall not pay
only [part] a
portion of a claim or
part
3-9 thereof that has been approved and is fully payable.
3-10 5. A court shall award costs
and reasonable attorney’s fees to the
3-11 prevailing party in an
action brought pursuant to this section.
3-12 Sec. 3. NRS 689B.255 is hereby amended to read as follows:
3-13 689B.255 1. Except as otherwise provided in subsection 2,
an insurer
3-14 shall approve or deny a
claim , or any part of the claim
that can be
3-15 approved or denied, relating to a policy of group health insurance or
3-16 blanket insurance within 30
days after the insurer receives the claim. If the
3-17 claim , or any part thereof, is approved, the
insurer shall pay the claim or
3-18 the part of the claim that has been approved within 30 days after [it] the
3-19 claim or part of the claim is approved. If the approved claim or the
3-20 approved part of the claim is not paid within that period, the insurer
shall
3-21 pay interest on the claim or approved part of the claim
at the rate of
3-22 interest established
pursuant to NRS 99.040 unless a different rate of
3-23 interest is established
pursuant to an express written contract between the
3-24 insurer and the provider of
health care. The interest must be calculated
3-25 from 30 days after the date
on which the claim or part of the
claim is
3-26 approved until the claim or approved part of the claim
is paid.
3-27 2. If the insurer requires
additional information to determine whether
3-28 to approve or deny the
claim, or any part thereof, it
shall notify the
3-29 claimant of its request for
the additional information within 20 days after it
3-30 receives the claim. The
insurer shall notify the provider of health care of all
3-31 the specific reasons for the
delay in approving or denying the claim [.] , or
3-32 part thereof. The insurer shall approve or deny the claim or the part of the
3-33 claim for which additional information was required within [30] 15 days
3-34 after receiving the
additional information. If the claim or the part of the
3-35 claim for which additional information was required is approved, the
3-36 insurer shall pay the claim or the part of the claim within
[30] 15 days
3-37 after it receives the
additional information. If the approved claim or the
3-38 approved part of the claim is not paid within that period, the insurer
shall
3-39 pay interest on the claim or approved part of the claim in
the manner
3-40 prescribed in subsection 1 [.] , except that the interest must be
calculated
3-41 from 15 days after the date on which the additional information is
3-42 received until the claim or approved part of the claim is paid.
3-43 3. An insurer shall not
request a claimant to resubmit information that
3-44 the claimant has already
provided to the insurer, unless the insurer provides
3-45 a legitimate reason for the
request and the purpose of the request in not to
3-46 delay the payment of the
claim, harass the claimant or discourage the filing
3-47 of claims.
3-48 4. An insurer shall not pay
only [part] a
portion of a claim or
part
3-49 thereof that has been approved and is fully payable.
4-1 5. A court shall award
costs and reasonable attorney’s fees to the
4-2 prevailing party in an
action brought pursuant to this section.
4-3 Sec. 4. NRS 689C.485 is hereby amended to read as follows:
4-4 689C.485 1. Except as otherwise provided in subsection 2,
a carrier
4-5 serving small employers and
a carrier that offers a contract to a voluntary
4-6 purchasing group shall
approve or deny a claim , or any
part of the claim
4-7 that can be approved or denied, relating to a policy of
health insurance
4-8 within 30 days after the
carrier receives the claim. If the claim , or any part
4-9 thereof, is approved, the carrier shall pay the claim or the part of the claim
4-10 that has been approved within 30 days after [it] the claim or part of the
4-11 claim is approved. If the approved claim or the approved part of the claim
4-12 is not paid within that
period, the carrier shall pay interest on the claim or
4-13 approved part of the claim at the rate of interest established pursuant
to
4-14 NRS 99.040 unless a
different rate of interest is established pursuant to an
4-15 express written contract
between the carrier and the provider of health care.
4-16 The interest must be
calculated from 30 days after the date on which the
4-17 claim or part of the claim is approved until the
claim or approved part of
4-18 the claim is paid.
4-19 2. If the carrier requires
additional information to determine whether to
4-20 approve or deny the claim, or any part thereof, it
shall notify the claimant
4-21 of its request for the
additional information within 20 days after it receives
4-22 the claim. The carrier shall
notify the provider of health care of all the
4-23 specific reasons for the
delay in approving or denying the claim [.] , or part
4-24 thereof. The carrier shall approve or deny the claim or the part of the
4-25 claim for which additional information was required within [30] 15 days
4-26 after receiving the
additional information. If the claim or the part of the
4-27 claim for which additional information was required is approved, the
4-28 carrier shall pay the claim or the part of the claim within
[30] 15 days
after
4-29 it receives the additional
information. If the approved claim
or the
4-30 approved part of the claim is not paid within that period, the carrier
shall
4-31 pay interest on the claim or approved part of the claim in
the manner
4-32 prescribed in subsection 1 [.] , except that the interest must be
calculated
4-33 from 15 days after the date on which the additional information is
4-34 received until the claim or approved part of the claim is paid.
4-35 3. A carrier shall not
request a claimant to resubmit information that
4-36 the claimant has already
provided to the carrier, unless the carrier provides
4-37 a legitimate reason for the
request and the purpose of the request is not to
4-38 delay the payment of the
claim, harass the claimant or discourage the filing
4-39 of claims.
4-40 4. A carrier shall not pay
only [part] a
portion of a claim
or part
4-41 thereof that has been approved and is fully payable.
4-42 5. A court shall award
costs and reasonable attorney’s fees to the
4-43 prevailing party in an
action brought pursuant to this section.
4-44 Sec. 5. NRS 695A.188 is hereby amended to read as follows:
4-45 695A.188 1. Except as otherwise provided in subsection 2,
a society
4-46 shall approve or deny a
claim , or any part of the claim
that can be
4-47 approved or denied, relating to a certificate of health insurance within
30
4-48 days after the society
receives the claim. If the claim ,
or any part thereof,
4-49 is approved, the society
shall pay the claim or the part of
the claim that
5-1 has been approved within 30 days after [it] the claim or part of the claim
5-2 is approved. If the approved
claim or the approved part of the
claim is not
5-3 paid within that period, the
society shall pay interest on the claim or
5-4 approved part of the claim at the rate of interest established pursuant
to
5-5 NRS 99.040 unless a
different rate of interest is established pursuant to an
5-6 express written contract
between the society and the provider of health
5-7 care. The interest must be
calculated from 30 days after the date on which
5-8 the claim or part of the claim is
approved until the claim or
approved part
5-9 of the claim is paid.
5-10 2. If the society requires
additional information to determine whether
5-11 to approve or deny the
claim, or any part thereof,
it shall notify the
5-12 claimant of its request for
the additional information within 20 days after it
5-13 receives the claim. The
society shall notify the provider of health care of all
5-14 the specific reasons for the
delay in approving or denying the claim [.] , or
5-15 part thereof. The society shall approve or deny the claim or part of the
5-16 claim for which additional information was required within [30] 15 days
5-17 after receiving the
additional information. If the claim or the part of the
5-18 claim for which additional information was required is approved, the
5-19 society shall pay the claim or the part of the claim
within [30] 15 days
5-20 after it receives the
additional information. If the approved claim or the
5-21 approved part of the claim is not paid within that period, the society
shall
5-22 pay interest on the claim or approved part of the claim
in the manner
5-23 prescribed in subsection 1 [.] , except that the interest must be
calculated
5-24 from 15 days after the date on which the additional information is
5-25 received until the claim or approved part of the claim is paid.
5-26 3. A society shall not
request a claimant to resubmit information that
5-27 the claimant has already
provided to the society, unless the society
5-28 provides a legitimate reason
for the request and the purpose of the request
5-29 is not to delay the payment
of the claim, harass the claimant or discourage
5-30 the filing of claims.
5-31 4. A society shall not pay
only [part] a
portion of a claim or
part
5-32 thereof that has been approved and is fully payable.
5-33 5. A court shall award
costs and reasonable attorney’s fees to the
5-34 prevailing party in an
action brought pursuant to this section.
5-35 Sec. 6. NRS 695B.2505 is hereby amended to read as follows:
5-36 695B.2505 1. Except as otherwise provided in subsection 2,
a
5-37 corporation subject to the
provisions of this chapter shall approve or deny a
5-38 claim , or any part of the claim that can be approved or denied,
relating to
5-39 a contract for dental,
hospital or medical services within 30 days after the
5-40 corporation receives the
claim. If the claim , or any part
thereof, is
5-41 approved, the corporation
shall pay the claim or the part of
the claim that
5-42 has been approved within 30 days after [it] the claim or part of the claim
5-43 is approved. If the approved
claim or the approved part of the
claim is not
5-44 paid within that period, the
corporation shall pay interest on the claim or
5-45 approved part of the claim at the rate of interest established pursuant
to
5-46 NRS 99.040 unless a
different rate of interest is established pursuant to an
5-47 express written contract
between the corporation and the provider of health
5-48 care. The interest must be
calculated from 30 days after the date on which
6-1 the claim or part of the claim is
approved until the claim or
approved part
6-2 of the claim is paid.
6-3 2. If the corporation
requires additional information to determine
6-4 whether to approve or deny
the claim, or any part thereof, it
shall notify
6-5 the claimant of its request
for the additional information within 20 days
6-6 after it receives the claim.
The corporation shall notify the provider of
6-7 dental, hospital or medical
services of all the specific reasons for the delay
6-8 in approving or denying the
claim [.] , or part thereof. The
corporation
6-9 shall approve or deny the
claim or the part of the claim for
which
6-10 additional information was required within [30] 15 days after receiving
6-11 the additional information.
If the claim or the part of the
claim for which
6-12 additional information was required is approved, the corporation
shall pay
6-13 the claim or the part of the claim
within [30] 15 days
after it receives the
6-14 additional information. If
the approved claim or the approved
part of the
6-15 claim is not paid within that period, the corporation shall pay interest on
6-16 the claim or approved part of the claim
in the manner prescribed in
6-17 subsection 1 [.] , except that the interest must be
calculated from 15 days
6-18 after the date on which the additional information is received
until the
6-19 claim or approved part of the claim is paid.
6-20 3. A corporation shall not
request a claimant to resubmit information
6-21 that the claimant has
already provided to the corporation, unless the
6-22 corporation provides a
legitimate reason for the request and the purpose of
6-23 the request is not to delay
the payment of the claim, harass the claimant or
6-24 discourage the filing of
claims.
6-25 4. A corporation shall not
pay only [part] a
portion of a claim or
part
6-26 thereof that has been approved and is fully payable.
6-27 5. A court shall award
costs and reasonable attorney’s fees to the
6-28 prevailing party in an
action brought pursuant to this section.
6-29 Sec. 7. NRS 695C.185 is hereby amended to read as follows:
6-30 695C.185 1. Except as otherwise provided in subsection 2,
a health
6-31 maintenance organization
shall approve or deny a claim , or
any part of the
6-32 claim that can be approved or denied, relating to a health care
plan within
6-33 30 days after the health
maintenance organization receives the claim. If the
6-34 claim , or any part thereof, is approved, the
health maintenance
6-35 organization shall pay the
claim or the part of the claim
that has been
6-36 approved within 30 days after [it] the claim or part of the claim is
6-37 approved. If the approved
claim or the approved part of the
claim is not
6-38 paid within that period, the
health maintenance organization shall pay
6-39 interest on the claim or approved part of the claim
at the rate of interest
6-40 established pursuant to NRS
99.040 unless a different rate of interest is
6-41 established pursuant to an
express written contract between the health
6-42 maintenance organization and
the provider of health care. The interest must
6-43 be calculated from 30 days
after the date on which the claim or
part of the
6-44 claim is approved until the claim or approved part of the claim is paid.
6-45 2. If the health
maintenance organization requires additional
6-46 information to determine
whether to approve or deny the claim, or any part
6-47 thereof, it shall notify the claimant of its request for the additional
6-48 information within 20 days
after it receives the claim. The health
6-49 maintenance organization
shall notify the provider of health care services
7-1 of all the specific reasons
for the delay in approving or denying the claim
7-2 [.] , or part thereof. The health maintenance
organization shall approve or
7-3 deny the claim or the part of the claim for which
additional information
7-4 was required within [30] 15 days after receiving the additional
7-5 information. If the claim or the part of the claim for which
additional
7-6 information was required is approved, the health maintenance
7-7 organization shall pay the
claim or the part of the claim
within [30] 15
7-8 days after it receives the
additional information. If the approved claim or
7-9 the approved part of the claim is not paid within that period, the health
7-10 maintenance organization
shall pay interest on the claim or
approved part
7-11 of the claim in the manner prescribed in subsection 1 [.] , except that the
7-12 interest must be calculated from 15 days after the date on which
the
7-13 additional information is received until the claim or approved part
of the
7-14 claim is paid.
7-15 3. A health maintenance
organization shall not request a claimant to
7-16 resubmit information that the
claimant has already provided to the health
7-17 maintenance organization,
unless the health maintenance organization
7-18 provides a legitimate reason
for the request and the purpose of the request
7-19 is not to delay the payment
of the claim, harass the claimant or discourage
7-20 the filing of claims.
7-21 4. A health maintenance
organization shall not pay only [part] a
7-22 portion of a claim or part thereof
that has been approved and is fully
7-23 payable.
7-24 5. A court shall award
costs and reasonable attorney’s fees to the
7-25 prevailing party in an
action brought pursuant to this section.
7-26 Sec. 8. This act becomes effective upon passage and approval.
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