2001 REGULAR SESSION (71st) A SB99 583
ASSEMBLY ACTION Initial and Date |SENATE ACTION Initial and Date
Adopted Lost | Adopted Lost
Concurred In Not |Concurred In Not
Receded Not | Receded Not
Amend the bill as a whole by renumbering section 1 as sec. 1.5 and adding a new section designated section 1, following the enacting clause, to read as follows:
“Section 1. NRS 679B.138 is hereby amended to read as follows:
679B.138 1. The commissioner shall adopt regulations which require the use of uniform claim forms and billing codes and the ability to make compatible electronic data transfers for all insurers and administrators authorized to conduct business in this state relating to a health care plan or health insurance or providing or arranging for the provision of health care services, including, without limitation, an insurer that issues a policy of health insurance, an insurer that issues a policy of group health insurance, a carrier serving small employers, a fraternal benefit society, a hospital or medical service corporation, a health maintenance organization, a plan for dental care and a prepaid limited health service organization. The regulations must include, without limitation, a uniform billing format to be used for the submission of claims to such insurers and administrators.
2. As used in this section:
(a) “Administrator” has the meaning ascribed to it in NRS 683A.025.
(b) “Health care plan” means a policy, contract, certificate or agreement offered or issued by an insurer to provide, deliver, arrange for, pay for or reimburse any of the costs of health care services.”.
Amend section 1, pages 1 and 2, by deleting lines 7 through 19 on page 1 and lines 1 through 3 on page 2, and inserting:
“administrator shall pay interest on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the administrator and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend section 1, page 2, by deleting lines 24 through 26 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend section 1, page 2, by deleting lines 34 and 35 and inserting:
“section, the commissioner may require the administrator to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend sec. 3, pages 2 and 3, by deleting lines 48 and 49 on page 2 and lines 1 through 13 on page 3, and inserting:
“on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the insurer and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend sec. 3, page 3, by deleting lines 33 through 35 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend sec. 3, page 3, by deleting line 43 and inserting:
“require the insurer to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend sec. 5, page 4, by deleting lines 9 through 23 and inserting:
“shall pay interest on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the insurer and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend sec. 5, page 4, by deleting lines 43 through 45 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend sec. 5, page 5, by deleting line 4 and inserting:
“require the insurer to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend sec. 7, page 5, by deleting lines 20 through 34 and inserting:
“shall pay interest on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the carrier and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend sec. 7, page 6, by deleting lines 5 through 7 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend sec. 7, page 6, by deleting line 15 and inserting:
“require the carrier to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend sec. 10, pages 6 and 7, by deleting lines 36 through 47 on page 6 and lines 1 through 3 on page 7, and inserting:
“interest on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the corporation and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend sec. 10, page 7, by deleting lines 24 through 26 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend sec. 10, page 7, by deleting lines 34 and 35 and inserting:
“commissioner may require the corporation to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend sec. 15, page 9, by deleting lines 3 through 18 and inserting:
“shall pay interest on the claim at [the] a rate of interest [established pursuant to NRS 99.040 unless a different rate of interest is established pursuant to an express written contract between the health maintenance organization and the provider of health care.] 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 days after the date on which the claim is approved until the date on which the claim is paid.”.
Amend sec. 15, page 9, by deleting lines 41 through 43 and inserting:
“6. The payment of interest provided for in this section for the late payment of an approved claim may not be waived.”.
Amend sec. 15, page 10, by deleting lines 2 through 4 and inserting:
“the requirements set forth in this section, the commissioner may require the health maintenance organization to pay an administrative fine in an amount to be determined by the commissioner.”.
Amend the bill as a whole by deleting sec. 17, renumbering sec. 18 as sec. 22 and adding new sections designated sections 17 through 21, following sec. 16, to read as follows:
“Sec. 17. Chapter 616C of NRS is hereby amended by adding thereto the provisions set forth as sections 18 and 19 of this act.
Sec. 18. 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. 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 bill for accident benefits may not be waived.
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.
Sec. 19. 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.
Sec. 20. NRS 616C.065 is hereby amended to read as follows:
616C.065 1. [Within] Except as otherwise provided in section 18 of this act, within 30 days after the insurer has been notified of an industrial accident, every insurer shall:
(a) Commence payment of a claim for compensation; or
(b) Deny the claim and notify the claimant and administrator that the claim has been denied.
FLUSH
Payments made by an insurer pursuant to this section are not
an admission of liability for the claim or any portion of the claim.
2. If an insurer unreasonably delays or refuses to pay that portion of the claim for compensation that is not required to be paid pursuant to section 18 of this act within 30 days after the insurer has been notified of an industrial accident, the insurer shall pay upon order of the administrator an additional amount equal to three times the amount specified in the order as refused or unreasonably delayed. This payment is for the benefit of the claimant and must be paid to him with the compensation assessed pursuant to chapters 616A to 617, inclusive, of NRS.
Sec. 21. NRS 616C.135 is hereby amended to read as follows:
616C.135 1. A provider of health care who accepts a patient as a referral for the treatment of an industrial injury or an occupational disease may not charge the patient for any treatment related to the industrial injury or occupational disease, but must charge the insurer. The provider of health care may charge the patient for any [other unrelated services which are requested in writing by the patient.] services that are not related to the employee’s industrial injury or occupational disease.
2. The insurer is liable for the charges for approved services related to the industrial injury or occupational disease if the charges do not exceed:
(a) The fees established in accordance with NRS 616C.260 or the usual fee charged by that person or institution, whichever is less; and
(b) The charges provided for by the contract between the provider of health care and the insurer or the contract between the provider of health care and the organization for managed care.
3. If a provider of health care, an organization for managed care, an insurer or an employer violates the provisions of this section, the administrator shall impose an administrative fine of not more than $250 for each violation.”.
Amend sec. 18, page 11, by deleting line 28 and inserting:
“care, the amendatory provisions of sections 1.5, 3, 5, 7, 10, 11, 15 and 18 of”.
Amend the bill as a whole by deleting sec. 19.