Action by insurer on bill from provider of health care; payment of interest; request for additional information; compliance with requirements.
1. Except as otherwise provided in this section, an insurer shall approve or deny a bill for accident benefits received from a provider of health care within 30 calendar days after the insurer receives the bill. If the bill for accident benefits is approved, the insurer shall pay the bill within 30 calendar days after it is approved. Except as otherwise provided in this section, if the approved bill for accident benefits is not paid within that period, the insurer shall pay interest to the provider of health care at a rate of interest equal to the prime rate at the largest bank in Nevada, as ascertained by the Commissioner of Financial Institutions, on January 1 or July 1, as the case may be, immediately preceding the date on which the payment was due, plus 6 percent. The interest must be calculated from 30 calendar days after the date on which the bill is approved until the date on which the bill is paid.
2. If an insurer needs additional information to determine whether to approve or deny a bill for accident benefits received from a provider of health care, he shall notify the provider of health care of his request for the additional information within 20 calendar days after he receives the bill. The insurer shall notify the provider of health care of all the specific reasons for the delay in approving or denying the bill for accident benefits. Upon the receipt of such a request, the provider of health care shall furnish the additional information to the insurer within 20 calendar days after receiving the request. If the provider of health care fails to furnish the additional information within that period, the provider of health care is not entitled to the payment of interest to which he would otherwise be entitled for the late payment of the bill for accident benefits. The insurer shall approve or deny the bill for accident benefits within 20 calendar days after he receives the additional information. If the bill for accident benefits is approved, the insurer shall pay the bill within 20 calendar days after he receives the additional information. Except as otherwise provided in this subsection, if the approved bill for accident benefits is not paid within that period, the insurer shall pay interest to the provider of health care at the rate set forth in subsection 1. The interest must be calculated from 20 calendar days after the date on which the insurer receives the additional information until the date on which the bill is paid.
3. An insurer shall not request a provider of health care to resubmit information that the provider of health care has previously provided to the insurer, unless the insurer provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the accident benefits, harass the provider of health care or discourage the filing of claims.
4. An insurer shall not pay only a portion of a bill for accident benefits that has been approved and is fully payable.
5. The Administrator may require an insurer to provide evidence which demonstrates that the insurer has substantially complied with the requirements of this section, including, without limitation, payment within the time required of at least 95 percent of approved accident benefits or at least 90 percent of the total dollar amount of approved accident benefits. If the Administrator determines that an insurer is not in substantial compliance with the requirements of this section, the Administrator may require the insurer to pay an administrative fine in an amount to be determined by the Administrator.
6. The payment of interest provided for in this section for the late payment of an approved claim may be waived only if the payment was delayed because of an act of God or another cause beyond the control of the insurer.
7. Payments made by an insurer pursuant to this section are not an admission of liability for the accident benefits or any portion of the accident benefits.
Last modified: February 25, 2006