NAC442.775. Payment or denial of claim for medical services: Notification of denial to provider; procedure for review of denial and appeal of decision of Bureau.

     1. A program specialist shall determine whether to pay a claim for services furnished by a provider.

     2. If the program specialist determines that the claim will not be paid, he or she shall notify the provider, in writing, of the reason why the claim will not be paid.

     3. The provider may request a review of the decision denying payment of the claim.

     4. The provider must submit a written request to the Bureau within 30 days after receiving notice that the claim has been denied.

     5. If the Bureau receives a request for a review pursuant to subsection 4, it shall issue a written decision and notify the provider, in writing, of its decision.

     6. The provider may appeal the decision of the Bureau in the manner prescribed in NAC 439.190 to 439.395, inclusive.

     (Added to NAC by Bd. of Health, eff. 11-27-89; A 1-18-94; 10-30-97; R212-97, 7-23-98)