1. Each managed care organization shall establish written criteria: (a) Setting forth the manner in which it determines whether to authorize coverage of a health care service; and (b) Setting forth its method for reviewing standards for the quality of health care services provided to an insured. 2. Such written criteria must be: (a) Developed with the assistance of practicing providers of health care; (b) Developed using generally recognized and, if appropriate, specialized clinical principles and processes; (c) Reviewed at least one time each year and, if appropriate, updated; and (d) Made available to an insured for review upon request of the insured any time that the managed care organization denies coverage of a specific health care service to the insured. (Added to NRS by 1997, 302)
Nevada Legal Code