NAC686A.304. Processing of claims: Duties of payer; date of receipt of claim.

     1. Each payer shall establish a tracking system to monitor the timeliness of the payer’s processing of a claim.

     2. Each payer shall:

     (a) Maintain a written or electronic record of the date of receipt of a claim;

     (b) For receipt of a written claim, date-stamp the claim with the date received; and

     (c) For receipt of an electronic claim, assign the document a batch number that includes the date received.

     3. Except as otherwise provided in subsection 5, a claim is deemed to have been received by a payer on the date of receipt of the claim stated in the written or electronic record required pursuant to subsection 2.

     4. A payer shall provide, within 20 working days after a request by a health care practitioner, hospital, institutional provider or person entitled to reimbursement, verification of the date of receipt of a claim as stated in the written or electronic record pursuant to subsection 2, in:

     (a) Electronic form, if the request was for electronic verification; or

     (b) Written form, including microfilm, if the request was for written verification.

     5. A claim shall be deemed received by a payer:

     (a) Five working days after the date the health care practitioner, hospital, institutional provider or person entitled to reimbursement placed the claim in the United States mail, if the health care practitioner, hospital, institutional provider or person entitled to reimbursement possesses the receipt of mailing the claim; or

     (b) On the date the receipt of the claim is recorded by a courier, if the claim was delivered by a courier.

     (Added to NAC by Comm’r of Insurance by R175-01, eff. 5-23-2002)