NAC683A.285. Registration of insurer; plan for utilization review; insurer to report changes; renewal of registration.

     1. An insurer shall not perform utilization review for another person unless it registers 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.

     2. An insurer may apply for registration by filing with the Commissioner the following information on a form provided by the Commissioner:

     (a) The insurer’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 insurer;

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

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

     3. An insurer that registers as an agent who performs utilization review shall file with the Commissioner any material changes in the information provided pursuant to subsection 2 within 30 days after the change occurs.

     4. The Commissioner will not evaluate the plan submitted pursuant to paragraph (d) of subsection 2. The Commissioner will make the plan available upon request and charge the fee set forth in NAC 683A.295 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.

     (Added to NAC by Comm’r of Insurance, eff. 1-24-92; A by R152-99, 1-28-2000)