NAC683A.600. Application for initial issuance of certificate: Generally.

Except as otherwise provided in NAC 683A.610, an external review organization applying for the initial issuance of a certificate to conduct external reviews must submit to the Commissioner, on a form prescribed by the Commissioner, an application in writing and must provide to the Commissioner at the time of application:

     1. A written statement that identifies:

     (a) The number of external reviewers that the external review organization employs, contracts with or otherwise retains to conduct external reviews;

     (b) The specialty of each external reviewer;

     (c) Whether each external reviewer is certified by the entity that regulates his or her specialty; and

     (d) The schedule of fees that the external review organization will charge to conduct an external review.

     2. A written summary of the procedures that the external review organization will use to:

     (a) Ensure that the external review organization conducts its activities in accordance with NRS 695G.241 to 695G.310, inclusive;

     (b) Ensure that an external reviewer employed, contracted with or otherwise retained by the external review organization is qualified to conduct a specific external review;

     (c) Ensure that a determination submitted for external review is a final adverse determination;

     (d) Ensure that a final review is conducted in a timely manner in accordance with NRS 695G.251, 695G.261 and 695G.271;

     (e) Ensure that the external review organization and any employee, agent or contractor of the external review organization does not have a conflict of interest as set forth in subsection 4 of NRS 683A.371; and

     (f) Submit a copy of the determination regarding an external review to:

          (1) The insured;

          (2) The physician of the insured;

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

          (4) The managed care organization.

     3. A written affidavit that:

     (a) The information contained in the application and any accompanying materials are complete and correct;

     (b) The external review organization will conduct external reviews in accordance with NRS 695G.241 to 695G.310, inclusive;

     (c) The external review organization and any employee, agent or contractor of the external review organization will avoid a conflict of interest as set forth in subsection 4 of NRS 683A.371; and

     (d) The external review organization is not affiliated with:

          (1) A health care plan; or

          (2) A national, state or local trade association.

     4. All applicable fees required, including, without limitation, all applicable fees required pursuant to NAC 683A.640, for the issuance of a certificate to conduct external reviews.

     (Added to NAC by Comm’r of Insurance by R128-03, eff. 2-12-2004; A by R103-09, 1-28-2010)