NRS683A.378. Prerequisites to conducting utilization review; registration of agent; plan for utilization review; agent to report changes.

      1.  A person shall not conduct utilization review unless the person is:

      (a) Registered with the Commissioner as an agent who performs utilization review and has a medical director who is a physician or, in the case of an agent who reviews dental services, a dentist, licensed in any state; or

      (b) Employed by a registered agent who performs utilization review.

      2.  A person may apply for registration by filing with the Commissioner a $250 fee and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110 and the following information on a form provided by the Commissioner:

      (a) The applicant’s name, address, telephone number and normal business hours;

      (b) The name and telephone number of a person the Commissioner may contact for information concerning the applicant;

      (c) The name of the medical director of the applicant and the state in which he or she is licensed to practice medicine or dentistry; and

      (d) A summary of the plan for utilization review, including procedures for appealing determinations made through utilization review.

      3.  An agent who performs utilization review shall file with the Commissioner any material changes in the information provided pursuant to subsection 1 within 30 days after the change occurs.

      4.  The Commissioner shall not evaluate the plan submitted pursuant to paragraph (d) of subsection 2. The Commissioner shall make the plan available upon request and shall charge a reasonable fee for providing a copy of the plan.

      5.  Registration pursuant to this section must be renewed on or before March 1 of each year by providing the information specified in subsection 2 and paying a renewal fee of $250 and, in addition to any other fee or charge, all applicable fees required pursuant to NRS 680C.110.

      (Added to NRS by 1991, 802; A 2009, 1776)