Revises provisions relating to the payment of claims under policies of health insurance. (BDR 57-367)

- 83rd Session (2025)
Assembly Bill No. 52–Committee
on Commerce and Labor

CHAPTER..........

AN ACT relating to insurance; requiring the Commissioner of
Insurance to establish programs to inform providers of health
care and insureds under health insuranc e policies
of certain information relating to the payment of claims;
revising provisions governing the payment of claims under
policies of health insurance; establishing certain
administrative penalties; requiring a health carrier to provide
certain infor mation to participating providers of health care
and covered persons; requiring a health carrier to establish
certain procedures for challenging the denial of a claim; and
providing other matters properly relating thereto.
Legislative Counsel’s Digest:
In most cases, existing law requires the administrators of health insurance plans
and certain health insurers to approve or deny a claim within 30 days after the
insurer receives the claim. If the administrator or insurer approves the claim,
existing law req uires the administrator or insurer to pay the claim within 30 days
after the claim is approved. If the administrator or insurer requires additional
information to determine whether to approve or deny the claim, existing law
requires the administrator or in surer to notify the claimant of its request for
additional information within 20 days after the administrator or insurer receives the
claim. If the administrator or insurer approves the claim after receiving such
additional information from the claimant, e xisting law requires the administrator or
insurer to pay the claim within 30 days after receiving such information. Existing
law requires an administrator or insurer that fails to pay a claim within the required
time period to pay interest on the claim at a prescribed rate. (NRS 287.04335,
683A.0879, 689A.410, 689B.255, 689C.335, 695A.188, 695B.2505, 695C.185,
695D.215, 695F.090)
Sections 2, 5, 8-11, 14 and 16 of this bill replace those requirements with
uniform requirements governing the time periods for the payment of health
insurance claims that apply to administrators of health insurance plans and all
private health insurers in this State . Specifically, sections 2, 5, 8-11, 14 and 16
require each such administrator or insurer to approve or deny a claim and, if the
claim is approved, pay the claim within: (1) twenty-one days after receiving
the claim, if the claim is submitted electronically; or (2) thirty days after receiving
the claim, if the claim is not submitted electronically. Sections 2, 5, 8-11, 14 and
16 require an administrator or insurer that needs additional information to
determine whether to approve or deny a claim to request such information within
20 working days after receiving the claim. If, after receiving such additional
information, the administrator or insurer approves the claim, sections 2, 5, 8-11, 14
and 16 require the administrator or insurer, as applicable, to pay the claim within:
(1) twenty-one days after receiving the additional information, if the additional
information is s ubmitted electronically; or (2) thirty days after receiving the
additional information, if the additional information is not submitted electronically.
Sections 2, 5, 8 -11, 14 and 16 prohibit an administrator or insurer from denying a
claim without a reason able basis for doing so. Sections 2, 5, 8-11, 14 and 16
require an administrator or insurer to annually report to the Commissioner of

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Insurance certain information relating to compliance with those requirements.
Section 25 of this bill repeals certain provisions applicable to health maintenance
organizations that are no longer necessary because existing law makes the
provisions of section 16 applicable to all managed care organizations, including
health maintenance organizations. (NRS 695C.055) Sections 13 and 18 of this bill
update references to a section repealed by section 25 with a reference to section 16.
Existing law authorizes the Commissioner to: (1) impose an administrative
penalty upon determining that the adminis trator of a health insurance plan or
certain health insurers are not in substantial compliance with the provisions of
existing law governing the schedule for paying claims; and (2) suspend or revoke
the certificate of registration or authority of such an a dministrator or insurer upon a
second or subsequent determination that such an administrator or insurer is not in
substantial compliance with those provisions. (NRS 287.04335, 683A.0879,
689A.410, 689B.255, 689C.335, 695B.2505, 695C.185, 695F.090) Sections 10, 14
and 16 of this bill extend those penalties to apply to fraternal benefit societies,
issuers of plans for dental care and managed care organizations. Sections 2, 5, 8-11,
14 and 16 additionally authorize the Commissioner to: (1) impose an
administrative penalty upon determining that the administrator of a health insurance
plan or a health insurer has failed to approve or deny a claim or pay an approved
claim within 60 working days after receiving the claim; and (2) suspend or revoke
the certificate o f registration or authority of an administrator or insurer upon a
second or subsequent such determination.
Existing law requires certain health insurers to provide certain notice to an
insured within 10 days after denying coverage. (NRS 689A.755, 689B.02 95,
695B.400, 695G.230) Sections 2, 6, 7, 9, 10, 12, 14, 15 and 18 of this bill require
health insurers and administrators of health insurance plans to provide notice of the
denial of a claim within 21 days after receiving all information necessary to make a
determination concerning the claim if the information is submitted electronically, or
if the information is not received electronically, within 30 days after receiving the
necessary information. Sections 2, 6, 7, 9, 10, 12, 14, 15 and 18 also require th e
inclusion of certain additional information in such a notice. Sections 10, 14 and 16
make certain other provisions relating to the payment of claims that currently apply
to most health insurers also apply to fraternal benefit societies, organizations for
dental care and managed care organizations so that the requirements governing the
payment of claims are uniform for all health insurers. Sections 2, 12.5 , 17.5 and
18.5 of this bill exempt coverage under Medicaid, the Children’s Health Insurance
Program and the Public Employees’ Benefits Program from the requirements of
sections 2, 8, 13, 16 and 18.
Existing law requires a health carrier which offers or issues a network plan to
notify each participating provider of health care in the network of the
responsibilities of the provider of health care with respect to any applicable
administrative policies and programs of the health carrier. (NRS 687B.730) Section
3 of this bill additionally requires such a health carrier to provide to each
participating provider of health care and each covered person at least annually an
explanation of the process by which the health carrier will provide remittances to or
pay claims submitted by participating providers of health care. Section 3 exempts
coverage by managed care or ganizations under Medicaid, the Children’s Health
Insurance Program and the Public Employees’ Benefits Program from all such
notification requirements.
Existing law requires a health carrier which offers or issues a network plan to
establish procedures f or the resolution of disputes between the health carrier and a
participating provider of health care. (NRS 687B.820) Section 4 of this bill requires
those procedures to include an efficient process by which a participating provider

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of health care may chall enge the denial by a health carrier of a claim. Section 4
exempts coverage by managed care organizations under Medicaid, the Children’s
Health Insurance Program and the Public Employees’ Benefits Program from the
requirement to establish such procedures . Section 1 of this bill requires the
Division of Insurance of the Department of Business and Industry to establish and
carry out certain programs to facilitate public knowledge and use of the provisions
of this bill.

EXPLANATION – Matter in bolded italics is new; matter between brackets [omitted material] is material to be omitted.

WHEREAS, Ensuring timely reimbursement for providers of
health care will enhance the business envir onment in this State for
providers of health care and improve access to health care for
residents of this State; and
WHEREAS, Prompt payment of claims by health insurers will
create a more stable and attractive landscape for new medical
practices, thereby improving the health care infrastructure of this
State; and
WHEREAS, Delayed payments by insurers have a
disproportionate negative effect on minority communities, whose
residents are less likely to have the means to pay out of pocket for
health care services; now, therefore,

THE PEOPLE OF THE STATE OF NEVADA, REPRESENTED IN
SENATE AND ASSEMBLY, DO ENACT AS FOLLOWS:

Section 1. NRS 679B.550 is hereby amended to read as
follows:
679B.550 The Division shall:
1. Establish a toll-free telephone service for receiving inquiries
and complaints from consumers of health care in this State
concerning health care plans;
2. Provide answers to inquiries of consumers of health care
concerning healt h care plans, or refer the consumers to the
appropriate agency, department or other entity that is responsible for
addressing the specific type of inquiry;
3. Refer consumers of health care to the appropriate agency,
department or other entity that is re sponsible for addressing the
specific type of complaint of the consumer;
4. Provide counseling and assistance to consumers of health
care concerning health care plans;
5. Educate consumers of health care concerning health care
plans in this State; [and]
6. Establish and carry out:

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(a) A campaign to inform providers of health care and
insureds of the provisions of NRS 683A.0879, 687B.730,
687B.820, 689A.410, 689A.755, 689B.0295, 689B.255, 689C.335,
695A.188, 695B.2505, 695B.400, 695D.215 and 695G.230 and
sections 15 and 16 of this act; and
(b) A program to provide additional support and resources to
assist providers of health care who operate small health care
practices or are new to operating a health care practice in:
(1) Navigating the process for seeking reimbursement from
insurers; and
(2) Ensuring that insurers comply with the requirements of
NRS 683A.0879, 687B.730, 687B.820, 689A.410, 689A.755,
689B.0295, 689B.255, 689C.335, 695A.188, 695B.2505, 695B.400,
695D.215 and 695G.230 and sections 15 and 16 of this act; and
7. Take such actions as are necessary to ensure public
awareness of the existence and purpose of the services provided by
the Division pursuant to this section.
Sec. 2. NRS 683A.0879 is hereby amended to read as follows:
683A.0879 1. Except as otherwise provided in subsection [2]
3 and NRS 439B.754, an administrator shall approve or deny a
claim relating to health insurance coverage and, if the
administrator:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after the administrator receives the
claim [. If the claim is approved, the administrator shall pay the
claim within 30 days after it is approved.] , if the claim is submitted
electronically; or
(2) Thirty days after the administrator receives the claim, if
the claim is not submitted electronically.
(b) Denies the claim, notify the claimant in writing of the
denial within 21 days after the administrator receives the claim , if
the claim is submitted electronically, or 30 days after the
administrator receives the claim, if the claim is not submitted
electronically. The notice must include, without limitation:
(1) All reasons for denying the claim , including, without
limitation, the specific facts and provisions of the policy relied
upon by the administrator as a basis to deny the claim;
(2) The criteria by which the administrator determines
whether to approve or deny the claim and a description of the
manner in which the administrator applied those criteria to the
claim; and
(3) A summary of any applicable process established
pursuant to NRS 687B.820 for challenging the denial of the claim.

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2. Except as otherwise provided in this section, if the approved
claim is not paid within [that] the period [,] specified in subsection
1, the administrator shall pay interest on the claim 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 ] 10 percent [.] per
annum. The interest must be calculated from [30 days after ] the
date on which payment of the claim is [approved] due pursuant to
subsection 1 until the date on which the claim is paid.
[2.] 3. If the administrator requires additional information to
determine whether to approve or deny the claim, the administrator
shall notify the claimant of the administrator’s request for the
additional information within 20 working days after receiving the
claim. The administrator shall notify the [provider of health care]
claimant of all the specific reasons for the delay in approving or
denying the claim. The administrator shall approve or deny the
claim and, if the administrator:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after recei ving the additional
information, if the information is submitted electronically; or
(2) Thirty days after receiving the additional information [. If
the claim is approved, the administrator shall pay the claim within
30 days after receiving the addition al information. ] , if the
information is not submitted electronically.
(b) Denies the claim, provide notice of the denial in the
manner prescribed in paragraph (b) of subsection 1 within 21 days
after receiving the additional information , if the informati on is
submitted electronically, or 30 days after receiving the additional
information, if the information is not submitted electronically.
4. If [the] a claim approved [claim] pursuant to subsection 3 is
not paid within [that] the period [,] specified in that subsection, the
administrator shall pay interest on the claim in the manner
prescribed in subsection [1.] 2.
[3.] 5. An administrator shall not [request] :
(a) Deny a claim relating to health insurance coverage without
a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the claimant
has already provided to the administrator, unless the administrator
provides a legitimate reason for the request and the purpose of the
request is not to delay the payment of the claim, harass the claimant
or discourage the filing of claims.

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[4.] 6. An administrator shall not pay only part of a claim that
has been approved and is fully payable.
[5.] 7. A court shall award costs and reasonable attorney’s fees
to the prevailing party in an action brought pursuant to this section.
[6.] 8. 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 administrator.
[7.] 9. The Commissioner may require an administrator to
provide evidence which demonstrates that the administrator has
substantially complied with the requirements set forth in this
section, including, without l imitation, payment within [30 days] the
time periods specified by this section of at least 95 percent of
approved claims or at least 90 percent of the total dollar amount for
approved claims.
[8.] 10. If the Commissioner determines that an administrator
is not in substantial compliance with the requirements set forth in
this section [,] or has failed to approve or deny a claim or pay an
approved claim within 60 working days after receiving the claim,
the Commissioner may require the administrator to pay a n
administrative fine in an amount to be determined by the
Commissioner. Upon a second or subsequent determination that an
administrator is not in substantial compliance with the requirements
set forth in this section [,] or has failed to approve or deny a claim
or pay an approved claim within 60 working days after receiving
the claim, the Commissioner may suspend or revoke the certificate
of registration of the administrator.
11. On or before February 1 of each year, an administrator
that was responsible for the approval and denial of claims relating
to health insurance coverage in this State during the immediately
preceding calendar year shall submit to the Commissioner a report
concerning the compliance of the administrator with the
requirements of this section during that calendar year. The report
must include, without limitation:
(a) The number of claims for which the administrator failed to
comply with the requirements of sub sections 1 and 3 during the
immediately preceding calendar year; and
(b) The total amount of interest paid by the administrator
pursuant to subsections 2 and 4 during the immediately preceding
calendar year.
12. The provisions of this section do not app ly to a claim
relating to health coverage under Medicaid, the Children’s Health
Insurance Program or the Public Employees’ Benefits Program.

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Sec. 3. NRS 687B.730 is hereby amended to read as follows:
687B.730 1. A health carrier which offers or issues a network
plan shall [notify] :
(a) Notify each participating provider of health care in the
network of the responsibilities of the participating provider of health
care with respect to any applicable administrative policies and
programs of the health carrier including, without limitation, any
applicable administrative policies and programs concerning:
[1.] (1) Terms of payment;
[2.] (2) Utilization review;
[3.] (3) Quality assessment and improvement;
[4.] (4) Credentialing;
[5.] (5) Procedures for grievances and appeals;
[6.] (6) Requirements for data reporting;
[7.] (7) Requirements for timely notice to the health carrier of
changes in the practices of the participating provider of health care,
such as discontinuance of accepting new patients;
[8.] (8) Requirements for confidentiality; and
[9.] (9) Any applicable federal or state programs.
(b) Provide to each participating provider of health care in the
network and each covered person at least annually a detailed
explanation of the process by which the health carrier will pay
claims submitted by participating providers of health care,
including, without limitation, the contact information for the
department of the health carrier that is responsible for rev iewing
claims that have been denied in accordance with the process
established pursuant to NRS 687B.820.
2. The provisions of this section do not apply to the provision
of health care services by a managed care organization to:
(a) Recipients of Medica id under the State Plan for Medicaid
or insurance pursuant to the Children’s Health Insurance
Program pursuant to a contract with the Division of Health Care
Financing and Policy of the Department of Health and Human
Services; or
(b) Members of the Public Employees’ Benefits Program.
3. As used in this section, “managed care organization” has
the meaning ascribed to it in NRS 695G.050.
Sec. 4. NRS 687B.820 is hereby amended to read as follows:
687B.820 1. A health carrier which offers or issues a network
plan shall establish procedures for the resolution of administrative,
payment or other disputes between a participating provider of health
care in the network and the health carrier. Those procedures must
include, w ithout limitation, an efficient process by which a

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participating provider of health care may challenge the denial of a
claim by the health carrier. The process must allow for the clear
resolution of each challenge within a reasonable time.
2. The provisions of this section do not apply to the provision
of health care services by a managed care organization to:
(a) Recipients of Medicaid under the State Plan for Medicaid
or insurance pursuant to the Children’s Health Insurance
Program pursuant to a contr act with the Division of Health Care
Financing and Policy of the Department of Health and Human
Services; or
(b) Members of the Public Employees’ Benefits Program.
3. As used in this section, “managed care organization” has
the meaning ascribed to it in NRS 695G.050.
Sec. 5. NRS 689A.410 is hereby amended to read as follows:
689A.410 1. Except as otherwise provided in subsection 2
and NRS 439B.754, an insurer shall approve or deny a claim
relating to a policy of health insurance within 21 days after the
insurer receives the claim, if the claim is submitted electronically,
or 30 days after the insurer receives the claim [.] , if the claim is not
submitted electronically. If the claim is approved, the insurer shall
also pay the claim within [30 days after it is approved. ] that period.
Except as otherwise provided in this section, if the approved claim
is not paid within that period, the insurer shall pay interest on the
claim 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 ] 10
percent [.] per annum. The interest must be calculated from [30
days after ] the date on which payment of the claim is [approved]
due pursuant to this subsection until the date on which the claim is
paid.
2. If the insurer requires additional information to determine
whether to approve or deny t he claim, it shall notify the claimant of
its request for the additional information within 20 working days
after it receives the claim. The insurer shall notify the [provider of
health care ] claimant of all the specific reasons for the delay in
approving or denying the claim. The insurer shall approve or deny
the claim within 21 days after receiving the additional information,
if the additional information is submitted electronically, or 30 days
after receiving the additional information [.] , if the addit ional
information is not submitted electronically. If the claim is
approved, the insurer shall also pay the claim within [30 days after it
receives the additional information. ] that period. If the approved

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claim is not paid within that period, the insurer shall pay interest on
the claim in the manner prescribed in subsection 1.
3. An insurer shall not [request] :
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the claimant
has already provi ded 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 claim, harass the claimant or
discourage the filing of claims.
4. An insurer shall not pay only part of a claim that has been
approved and is fully payable.
5. A court shall award costs and reasonable attorney’s fees to
the prevailing party in an action brought pursuant to this section.
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. The Commissioner may require an insurer to provide
evidence which demonstrates that the insurer has substantially
complied with the requirements set forth in this section, including,
without limitation, payment within [30 days ] the time periods
specified by this section of at least 95 percent of approved claims or
at least 90 percent of the total dollar amount for approved claims.
8. If the Commissioner determines that an insurer is not in
substantial compliance with the requirements set forth in this section
[,] or that the insurer has failed to approve or deny a claim or pay
an approved claim within 60 working days after receiving the
claim, the Commissioner may require the insurer to pay an
administrative fine in an amount to be determined by the
Commissioner. Upon a second or subsequent determination that an
insurer is not in substantial compliance with the requirements set
forth in this section [,] or has failed to approve or deny a claim or
pay an approved claim within 60 working days after receivi ng the
claim, the Commissioner may suspend or revoke the certificate of
authority of the insurer.
9. On or before February 1 of each year, an insurer shall
submit to the Commissioner a report concerning the compliance
of the insurer with the requirements of this section during the
immediately preceding calendar year. The report must include,
without limitation:
(a) The number of claims for which the insurer failed to
comply with the requirements of subsections 1 and 2 during the
immediately preceding calendar year; and

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(b) The total amount of interest paid by the insurer pursuant to
subsections 1 and 2 during the immediately preceding calendar
year.
Sec. 6. NRS 689A.755 is hereby amended to read as follows:
689A.755 1. Following approval by the Commissioner, each
insurer that issues a policy of health insurance in this State shall
provide written notice to an insured, in clear and comprehensible
language that is understandable to an ordinary layperson, explaining
the right of the insured to file a written complaint. Such notice must
be provided to an insured:
(a) At the time the insured receives his or her evidence of
coverage;
(b) Any time that the insurer denies coverage of a health care
service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care
service to an insured, including, without limitation, denying a claim
relating to a policy of health insurance pursuant to NRS 689A.410,
it shall notify the insured and, if applicable, the provider of health
care who submitted the claim, in writing within :
(a) Twenty-one days after the insurer receives all information
necessary to make a deter mination concerning the claim , if the
information was submitted electronically;
(b) Thirty days after the insurer receives all information
necessary to make a determination concerning the claim, if the
information was not submitted electronically; or
(c) If no claim is received, within 10 working days after [it] the
insurer denies coverage of the health care service . [of:]
3. The notice required pursuant to subsection 2 must include,
without limitation:
(a) [The reason] All reasons for denying coverage of the service
[;] , including, without limitation, the specific facts and provisions
of the policy relied upon by the insurer as a basis to deny coverage
of the service;
(b) The criteria by which the insurer determines whether to
authorize or de ny coverage of the health care service [;] and a
description of the manner in which the insurer applied those
criteria to the health care service;
(c) A summary of any applicable process established pursuant
to NRS 687B.820 for challenging the denial of the claim; and
(d) The right of the insured to file a written complaint and the
procedure for filing such a complaint.

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[3.] 4. A written notice which is approved by the
Commissioner pursuant to subsection 1 shall be deemed to be in
clear and comprehensi ble language that is understandable to an
ordinary layperson.
Sec. 7. NRS 689B.0295 is hereby amended to read as follows:
689B.0295 1. Following approval by the Commissioner, each
insurer that issues a policy of group health insurance in this State
shall provide written notice to an insured, in clear and
comprehensible language that is understandable to an ordinary
layperson, explaining the right of the insured to file a written
complaint. Such notice must be provided to an insured:
(a) At the time the insured receives his or her certificate of
coverage or evidence of coverage;
(b) Any time that the insurer denies coverage of a health care
service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time that an insurer denies coverage of a health care
service, including, without limitation, denying a claim relating to a
policy of group health insurance or blanket insurance pursuant to
NRS 689B.255, to an insured it shall notify the insured in writing
within :
(a) Twenty-one days after the insurer receives all information
necessary to make a determination concerning the claim , if the
information is submitted electronically;
(b) Thirty days after the insurer receives all information
necessary to make a determination concerning the claim, if the
information is not submitted electronically; or
(c) If no claim is received, within 10 working days after [it] the
insurer denies coverage of the health care service . [of:]
3. The notice required pursuant to subsection 2 must include,
without limitation:
(a) [The reason] All reasons for denying coverage of the service
[;] , including, without limitation, the specific facts and pr ovisions
of the policy relied upon by the insurer as a basis to deny coverage
of the service;
(b) The criteria by which the insurer determines whether to
authorize or deny coverage of the health care service [;] and a
description of the manner in which th e insurer applied those
criteria to the health care service;
(c) A summary of any applicable process established pursuant
to NRS 687B.820 for challenging the denial of the claim; and
(d) The right of the insured to file a written complaint and the
procedure for filing such a complaint.

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[3.] 4. A written notice which is approved by the
Commissioner shall be deemed to be in clear and comprehensible
language that is understandable to an ordinary layperson.
5. If an insurer denies a claim submitted by a provider of
health care, the insurer shall notify the provider of health care in
writing of the denial within:
(a) Twenty-one days after the insurer receives all information
necessary to make a determination concerning the claim , if the
information is submitted electronically; or
(b) Thirty days after the insurer receives all information
necessary to make a determination concerning the claim , if the
information is not submitted electronically.
6. The notice required pursuant to subsection 5 must include,
without limitation:
(a) All reasons for denying the claim;
(b) The criteria by which the insurer determines whether to
approve or deny the claim and a description of the manner in
which the insurer applied those criteria to the claim;
(c) Any other legal or factual basis for denying the claim; and
(d) A summary of any applicable process established pursuant
to NRS 687B.820 for challenging the denial of the claim.
Sec. 8. NRS 689B.255 is hereby amended to read as follows:
689B.255 1. Except as otherwise provided in subsection 2
and NRS 439B.754, an insurer shall approve or deny a claim
relating to a policy of group health insurance or blanket insurance
within 21 days after the insurer receives the claim, if the claim is
submitted electronically, or 30 days after the insurer receives the
claim [.] , if the claim is not submitted electronically. If the claim is
approved, the insurer shall also pay the claim within [30 days after it
is approved. ] that period. Except as otherwise provided in this
section, if the approved claim is not paid within that period, the
insurer shall pay interest on the claim at a rate of [interest equal to
the prime rate at the largest bank in Nevada, as ascertained by the
Commissioner of Fi nancial Institutions, on January 1 or July 1, as
the case may be, immediately preceding the date on which the
payment was due, plus 6 ] 10 percent [.] per annum. The interest
must be calculated from [30 days after] the date on which payment
of the claim is [approved] due pursuant to this subsection until the
date on which the claim is paid.
2. If the insurer requires additional information to determine
whether to approve or deny the claim, it shall notify the claimant of
its request for the additional info rmation within 20 working days
after it receives the claim. The insurer shall notify the [provider of

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health care ] claimant of all the specific reasons for the delay in
approving or denying the claim. The insurer shall approve or deny
the claim within 21 days after receiving the additional information,
if the additional information is submitted electronically, or 30 days
after receiving the additional information [.] , if the additional
information is not submitted electronically. If the claim is
approved, the insurer shall also pay the claim within [30 days after it
receives the additional information. ] that period. If the approved
claim is not paid within that period, the insurer shall pay interest on
the claim in the manner prescribed in subsection 1.
3. An insurer shall not [request] :
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the claimant
has already 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 claim, harass the claimant or
discourage the filing of claims.
4. An insurer shall not pay only part of a claim that has been
approved and is fully payable.
5. A court shall awar d costs and reasonable attorney’s fees to
the prevailing party in an action brought pursuant to this section.
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. The Commissioner may require an insurer to provide
evidence which demonstrates that the insurer has substantially
complied with the requirements set forth in this section, in cluding,
without limitation, payment within [30 days ] the time periods
specified by this section of at least 95 percent of approved claims or
at least 90 percent of the total dollar amount for approved claims.
8. If the Commissioner determines that an in surer is not in
substantial compliance with the requirements set forth in this section
[,] or has failed to approve or deny a claim or pay an approved
claim within 60 working days after receiving the claim, the
Commissioner may require the insurer to pay a n administrative fine
in an amount to be determined by the Commissioner. Upon a second
or subsequent determination that an insurer is not in substantial
compliance with the requirements set forth in this section [,] or has
failed to approve or deny a claim or pay an approved claim within
60 working days after receiving the claim, the Commissioner may
suspend or revoke the certificate of authority of the insurer.

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- 83rd Session (2025)
9. On or before February 1 of each year, an insurer shall
submit to the Commissioner a report concerning the compliance
of the insurer with the requirements of this section during the
immediately preceding calendar year. The report must include,
without limitation:
(a) The number of claims for which the insurer failed to
comply with the requirements of subsections 1 and 2 during the
immediately preceding calendar year; and
(b) The total amount of interest paid by the insurer pursuant to
subsections 1 and 2 during the immediately preceding calendar
year.
Sec. 9. NRS 689C.335 is hereby amended to read as follows:
689C.335 1. Except as otherwise provided in subsection [2] 3
and NRS 439B.754, a carrier serving small employers and a carrier
that offers a contract to a voluntary purchasing group shall approve
or deny a claim relating to a policy of health insurance and, if the
carrier:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after the carrier re ceives the claim [. If
the claim is approved, the carrier shall pay the claim within 30 days
after it is approved.] , if the claim is submitted electronically; or
(2) Thirty days after the carrier receives the claim, if the
claim is not submitted electronically.
(b) Denies the claim, notify the claimant in writing of the
denial within 21 days after the carrier receives the claim , if the
claim is submitted electronically , or 30 days after the carrier
receives the claim, if the claim is not submitte d electronically. The
notice must include, without limitation:
(1) All reasons for denying the claim , including, without
limitation, the specific facts and provisions of the policy relied
upon by the carrier as a basis to deny the claim;
(2) The criteria by which the carrier determines whether to
approve or deny the claim and a description of the manner in
which the carrier applied those criteria to the claim; and
(3) A summary of any applicable process established
pursuant to NRS 687B.820 for challenging the denial of the claim.
2. Except as otherwise provided in this section, if the approved
claim is not paid within [that] the period [,] specified in subsection
1, the carrier shall pay interest on the claim 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] 10 percent [.] per annum. The interest

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- 83rd Session (2025)
must be calculated from [30 days after] the date on which payment
of the claim is [approved] due pursuant to subsection 1 until the
date on which the claim is paid.
[2.] 3. If the carrier requires additional information to
determine whether to approve or deny the claim, it shall notify the
claimant of its request for the additional information within 20
working days after it receives the claim. The carrier shall notify the
[provider of health care ] claimant of all the specific reasons for the
delay in approving or denying the claim. The carrier shall approve
or deny the claim and, if the carrier:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after receiving the additional
information, if the information is submitted electronically; or
(2) Thirty days after receiving the additional information [. If
the claim is approved, the carrier shall pay the claim within 30 days
after it receives the additional information. ] , if the information is
not submitted electronically.
(b) Denies the claim, provide notice of the denial in the
manner prescribed in paragraph (b) of subsection 1 within 21 days
after receiving the additional information , if the information is
submitted electronically, or 30 days after receiv ing the additional
information, if the information is not submitted electronically.
4. If [the approved] a claim approved pursuant to subsection 3
is not paid within [that] the period [,] specified in that subsection,
the carrier shall pay interest on the claim in the manner prescribed in
subsection [1.] 2.
[3.] 5. A carrier shall not [request] :
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the claimant
has already provided to the carrier, unless the carrier provides a
legitimate reason for the request and the purpose of the request is
not to delay the payment of the claim, harass the claimant or
discourage the filing of claims.
[4.] 6. A carrier shall not pay only part of a claim that has been
approved and is fully payable.
[5.] 7. A court shall award costs and reasonable attorney’s fees
to the prevailing party in an action brought pursuant to this section.
[6.] 8. The payment of interest provided for in this section for
the l ate 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 carrier.
[7.] 9. The Commissioner may require a carrier to provide
evidence which demonstrates that the car rier has substantially

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- 83rd Session (2025)
complied with the requirements set forth in this section, including,
without limitation, payment within [30 days ] the time periods
specified by this section of at least 95 percent of approved claims or
at least 90 percent of the total dollar amount for approved claims.
[8.] 10. If the Commissioner determines that a carrier is not in
substantial compliance with the requirements set forth in this section
[,] or has failed to approve or deny a claim or pay an approved
claim within 60 working days after receiving the claim, the
Commissioner may require the carrier to pay an administrative fine
in an amount to be determined by the Commissioner. Upon a second
or s ubsequent determination that a carrier is not in substantial
compliance with the requirements set forth in this section [,] or has
failed to approve or deny a claim or pay an approved claim within
60 working days after receiving the claim, the Commissioner may
suspend or revoke the certificate of authority of the carrier.
11. On or before February 1 of each year, a carrier shall
submit to the Commissioner a report concerning the compliance
of the carrier with the requirements of this section during the
immediately preceding calendar year. The report must include,
without limitation:
(a) The number of claims for which the carrier failed to
comply with the requirements of subsections 1 and 3 during the
immediately preceding calendar year; and
(b) The total amount of interest paid by the carrier pursuant to
subsections 2 and 4 d uring the immediately preceding calendar
year.
Sec. 10. NRS 695A.188 is hereby amended to read as follows:
695A.188 1. Except as otherwise provided in subsection [2] 3
and NRS 439B.754, a society shall approve or deny a claim relating
to a certificate of health insurance and, if the society:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after the society receives the claim [. If
the claim is approved, the society shall pay the claim within 30 days
after it is approved. If] , if the claim is submitted electronically; or
(2) Thirty days after the society receives the claim, if the
claim is not submitted electronically.
(b) Denies the claim, n otify the claimant in writing of the
denial within 21 days after the society receives the claim , if the
claim is submitted electronically , or 30 days after the society
receives the claim, if the claim is not submitted electronically. The
notice must include, without limitation:

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- 83rd Session (2025)
(1) All reasons for denying the claim , including, without
limitation, the specific facts and provisions of the certificate relied
upon by the society as a basis to deny the claim;
(2) The criteria by which the society determines whether to
approve or deny the claim and a description of the manner in
which the society applied those criteria to the claim; and
(3) A summary of any applicable process established
pursuant to NRS 687B.820 for challenging the denial of the claim.
2. Except as otherwise provided in this section, if the
approved claim is not paid within [that] the period [,] specified by
subsection 1, the society shall pay interest on the claim at the rate of
[interest established pursuant to NRS 99.040 unless a different rate
of interest is established pursuant to an express written contract
between the society and the provider of health care. ] 10 percent per
annum. The interest must be calculated from [30 days after ] the
date on which payment of the claim is [approved] due pursuant to
subsection 1 until the claim is paid.
[2.] 3. If the society requires additional information to
determine whether to approve or deny the claim, it shall notify the
claimant of its request for the additional information within 20
working days after it receives the claim. The society shall notify the
[provider of health care ] claimant of all the specific reasons for the
delay in approving or denying the claim. The society shall approve
or deny the claim and, if the society:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after receiving the additional
information, if the information is submitted electronically; or
(2) Thirty days after receiving the additional information [. If
the claim is approved, the society shall pay the claim within 30 days
after it receives the additional information. ] , if the information is
not submitted electronically.
(b) Denies the claim, provide notice of the denial in the
manner prescribed in paragraph (b) of subsection 1 within 21 days
after receiving the additional information , if the information is
submitted electronically , or 30 days after receiving the
information, if the information is not submitted electronically.
4. If [the approved] a claim approved pursuant to subsection 3
is not paid within [that] the period [,] specified in that subsection,
the society shall pay interest on the claim in the manner prescribed
in subsection [1.] 2.
[3.] 5. A society shall not [request] :
(a) Deny a claim without a reasonable basis for the denial.

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- 83rd Session (2025)
(b) Request a claimant to resubmit information that the claimant
has already provided to the society, unless the society provides a
legitimate reason for the request and the purpose of the request is
not to delay the payment of the c laim, harass the claimant or
discourage the filing of claims.
[4.] 6. A society shall not pay only part of a claim that has
been approved and is fully payable.
[5.] 7. A court shall award costs and reasonable attorney’s fees
to the prevailing party in an action brought pursuant to this section.
8. 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 society.
9. The Commissioner may require a society to provide
evidence which demonstrates that the society has substantially
complied with the requirements set forth in this section, including,
without limitation, payment within the time periods specif ied by
this section of at least 95 percent of approved claims or at least 90
percent of the total dollar amount for approved claims.
10. If the Commissioner determines that a society is not in
substantial compliance with the requirements set forth in thi s
section or has failed to approve or deny a claim or pay an
approved claim within 60 working days after receiving the claim,
the Commissioner may require the society to pay an administrative
fine in an amount to be determined by the Commissioner. Upon a
second or subsequent determination that a society is not in
substantial compliance with the requirements set forth in this
section or has failed to approve or deny a claim or pay an
approved claim within 60 working days after receiving the claim,
the Commis sioner may suspend or revoke the certificate of
authority of the society.
11. On or before February 1 of each year, a society shall
submit to the Commissioner a report concerning the compliance
of the society with the requirements of this section during the
immediately preceding calendar year. The report must include,
without limitation:
(a) The number of claims for which the society failed to
comply with the requirements of subsections 1 and 3 during the
immediately preceding calendar year; and
(b) The total amount of interest paid by the society pursuant to
subsections 2 and 4 d uring the immediately preceding calendar
year.

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- 83rd Session (2025)
Sec. 11. NRS 695B.2505 is hereby amended to read as
follows:
695B.2505 1. Except as otherwise provided in subsection 2
and NRS 439B.754, a corporation subject to the provisions of this
chapter shall approve or deny a claim relating to a contract for
dental, hospital or medical services within 21 days after the
corporation receives the claim, if the claim is submitted
electronically, or 30 days after the corporation receives the claim [.]
, if the claim is not submitted electronically. If the claim is
approved, the corporation shall also pay the claim within [30 days
after it is approved. ] that period. Except as otherwise provided in
this section, if the approved claim i s not paid within [that] that
period, the corporation shall pay interest on the claim 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 ] 10 percent [.] per
annum. The interest must be calculated from [30 days after ] the
date on which the payment of the claim is [approved] due pursuant
to this subsection until the date on which the claim is paid.
2. If the corporation requires additional information to
determine whether to approve or deny the claim, it shall notify the
claimant of its request for the additional information within 20
working days after it receives the claim. The corporation shall notify
the [provider of dental, hospital or medical services ] claimant of all
the specific reasons for the delay in approving or denying the claim.
The corporation shall approve or deny the claim within 21 days
after receiving the additional information, if the additional
information is submitted electronically, or 30 days after receiving
the additional information [.] , if the information is not submitted
electronically. If the claim is approved, the corporation shall pay the
claim within [30 days after it receives the additional information. ]
that period. If the approved claim is not paid within that period, the
corporation shall pay interest on the claim in the manner prescribed
in subsection 1.
3. A corporation shall not [request] :
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the claimant
has already provided to the corporation, unless the corporation
provides a legitimate reason for the request and the purpose of the
request is not to delay the payment of the claim, harass the claimant
or discourage the filing of claims.

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- 83rd Session (2025)
4. A corporation shall not pay only part of a claim that has
been approved and is fully payable.
5. A court shall a ward costs and reasonable attorney’s fees to
the prevailing party in an action brought pursuant to this section.
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 delay ed because of an act of God or another cause
beyond the control of the corporation.
7. The Commissioner may require a corporation to provide
evidence which demonstrates that the corporation has substantially
complied with the requirements set forth in th is section, including,
without limitation, payment within [30 days ] the time periods
specified by this section of at least 95 percent of approved claims or
at least 90 percent of the total dollar amount for approved claims.
8. If the Commissioner determi nes that a corporation is not in
substantial compliance with the requirements set forth in this section
[,] or has failed to approve or deny a claim or pay an approved
claim within 60 working days after receiving the claim, the
Commissioner may require the corporation to pay an administrative
fine in an amount to be determined by the Commissioner. Upon a
second or subsequent determination that a corporation is not in
substantial compliance with the requirements set forth in this section
[,] or has failed to approve or deny a claim or pay an approved
claim within 60 working days after receiving the claim, the
Commissioner may suspend or revoke the certificate of authority of
the corporation.
9. On or before February 1 of each year, a corporation shall
submit to the Commissioner a report concerning the compliance
of the corporation with the requirements of this section during the
immediately preceding calendar year. The report must include,
without limitation:
(a) The number of claims for which the corporat ion failed to
comply with the requirements of subsections 1 and 3 during the
immediately preceding calendar year; and
(b) The total amount of interest paid by the corporation
pursuant to subsections 1 and 2 during the immediately preceding
calendar year.
Sec. 12. NRS 695B.400 is hereby amended to read as follows:
695B.400 1. Following approval by the Commissioner, each
insurer that issues a contract for hospital or medical services in this
State shall provide written not ice to an insured, in clear and
comprehensible language that is understandable to an ordinary

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- 83rd Session (2025)
layperson, explaining the right of the insured to file a written
complaint. Such notice must be provided to an insured:
(a) At the time the insured receives a ce rtificate of coverage or
evidence of coverage;
(b) Any time that the insurer denies coverage of a health care
service or limits coverage of a health care service to an insured; and
(c) Any other time deemed necessary by the Commissioner.
2. Any time th at an insurer denies coverage of a health care
service to a beneficiary or subscriber, including, without limitation,
denying a claim relating to a contract for dental, hospital or medical
services pursuant to NRS 695B.2505, it shall notify the beneficiary
or subscriber in writing within :
(a) Twenty-one days after the insurer receives all information
necessary to make a determination concerning the claim , if the
information is submitted electronically;
(b) Thirty days after the insurer receives all information
necessary to make a determination concerning the claim , if the
information is not submitted electronically; or
(c) If no claim is received, 10 working days after [it] the
insurer denies coverage of the health care service of:
[(a) The reason]
(1) All reasons for denying coverage of the service [;] ,
including, without limitation, the specific facts and provisions of
the contract relied upon by the insurer as a basis to deny coverage
for the service;
[(b)] (2) The criteria by which the insurer determines whether to
authorize or deny coverage of the health care service [;] and the
manner in which the insurer applied those criteria to the health
care service;
(3) A summary of any applicable process established
pursuant to NRS 687B.820 f or challenging the denial of the
claim; and
[(c)] (4) The right of the beneficiary or subscriber to file a
written complaint and the procedure for filing such a complaint.
3. A written notice which is approved by the Commissioner
shall be deemed to be in clear and comprehensible language that is
understandable to an ordinary layperson.
Sec. 12.5. NRS 695C.050 is hereby amended to read as
follows:
695C.050 1. Except as otherwise provided in this chapter or
in specific provisions of this title, the provisions of this title are not
applicable to any health maintenance organization granted a
certificate of authority under this chapter. This provision does not

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- 83rd Session (2025)
apply to an insurer licensed and regulated pursuant to this ti tle
except with respect to its activities as a health maintenance
organization authorized and regulated pursuant to this chapter.
2. Solicitation of enrollees by a health maintenance
organization granted a certificate of authority, or its representatives ,
must not be construed to violate any provision of law relating to
solicitation or advertising by practitioners of a healing art.
3. Any health maintenance organization authorized under this
chapter shall not be deemed to be practicing medicine and is exempt
from the provisions of chapter 630 of NRS.
4. The provisions of NRS 695C.110, 695C.125, 695C.1691,
695C.1693, 695C.170, 695C.1703, 695C.1705, 695C.1709 to
695C.173, inclusive, 695C.1733, 695C.17335, 695C.1734,
695C.1751, 695C.1755, 695C.1759, 695C. 176 to 695C.200,
inclusive, and 695C.265 do not apply to a health maintenance
organization that provides health care services through managed
care to recipients of Medicaid under the State Plan for Medicaid or
insurance pursuant to the Children’s Health In surance Program
pursuant to a contract with the Division of Health Care Financing
and Policy of the Department of Health and Human Services. This
subsection does not exempt a health maintenance organization from
any provision of this chapter for services p rovided pursuant to any
other contract.
5. The provisions of NRS 695C.16932 to 695C.1699,
inclusive, 695C.1701, 695C.1708, 695C.1728, 695C.1731,
695C.17333, 695C.17345, 695C.17347, 695C.1736 to 695C.1745,
inclusive, 695C.1757 and 695C.204 apply to a heal th maintenance
organization that provides health care services through managed
care to recipients of Medicaid under the State Plan for Medicaid.
6. The provisions of NRS 695C.17095 and 695C.187 do not
apply to a health maintenance organization that provi des health care
services to members of the Public Employees’ Benefits Program.
This subsection does not exempt a health maintenance organization
from any provision of this chapter for services provided pursuant to
any other contract.
7. The provisions of NRS 695C.1735 do not apply to a health
maintenance organization that provides health care services to:
(a) The officers and employees, and the dependents of officers
and employees, of the governing body of any county, school district,
municipal corporati on, political subdivision, public corporation or
other local governmental agency of this State; or
(b) Members of the Public Employees’ Benefits Program.

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- 83rd Session (2025)
 This subsection does not exempt a health maintenance
organization from any provision of this chapt er for services
provided pursuant to any other contract.
Sec. 13. NRS 695C.187 is hereby amended to read as follows:
695C.187 1. A health maintenance organization shall not:
(a) Enter into any contract or agreement, or make any other
arrangements, with a provider for the provision of health care; or
(b) Employ a provider pursuant to a contract, an agreement or
any other arrangement to provide health care,
 unless the contract, agreement or other arrangement specificall y
provides that the health maintenance organization and provider
agree to the schedule for the payment of claims set forth in [NRS
695C.185.] section 16 of this act.
2. Any contract, agreement or other arrangement between a
health maintenance organization and a provider that is entered into
or renewed on or after [October] January 1, [2001,] 2026, that does
not specifically include a provision concerning the schedule for the
payment of claims as required by subsection 1 shall be deemed to
conform with the requirements of subsection 1 by operation of law.
Sec. 14. NRS 695D.215 is hereby amended to read as follows:
695D.215 1. Except as ot herwise provided in subsection [2,]
3, an organization for dental care shall approve or deny a claim
relating to a plan for dental care and, if the organization for dental
care:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after the organization for dental care
receives the claim [. If the claim is approved, the organization for
dental care shall pay the claim within 30 days after it is approved.
If] , if the claim is submitted electronically; or
(2) Thirty days after the organization for dental care
receives the claim, if the claim is not submitted electronically.
(b) Denies the claim, notify the claimant in writing of the
denial within 21 days after the organization for dental care
receives the claim, if the claim was su bmitted electronically, or 30
days after the organization for dental care receives the claim, if
the claim was not submitted electronically. The notice must
include, without limitation:
(1) All reasons for denying the claim , including, without
limitation, the specific facts and provisions of the plan relied upon
by the organization for dental care as a basis to deny the claim;
(2) The criteria by which the organization for dental care
determines whether to approve or deny the claim and a description

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- 83rd Session (2025)
of the manner in which the organization for dental care applied
those criteria to the claim; and
(3) A summary of any applicable process established
pursuant to NRS 687B.820 for challenging the denial of the claim.
2. Except as otherwise provided in this section, if the
approved claim is not paid within [that] the period [,] specified by
subsection 1, the organization for dental care shall pay interest on
the claim at the rate of [interest established pursuant to NR S
99.040.] 10 percent per annum. The interest must be calculated
from the date the payment of the claim is due pursuant to
subsection 1 until the claim is paid.
[2.] 3. If the organization for dental care requires additional
information to determine whet her to approve or deny the claim, it
shall notify the claimant of its request for the additional information
within 20 working days after it receives the claim. The organization
for dental care shall notify the [provider of dental care] claimant of
the rea son for the delay in approving or denying the claim. The
organization for dental care shall approve or deny the claim and, if
the organization for dental care:
(a) Approves the claim, pay the claim within [30] :
(1) Twenty-one days after receiving the a dditional
information, if the information is submitted electronically; or
(2) Thirty days after receiving the additional information [. If
the claim is approved, the organization for dental care shall pay the
claim within 30 days after it receives the additional information.] , if
the information is not submitted electronically.
(b) Denies the claim, provide notice of the denial in the
manner prescribed in paragraph (b) of subsection 1 within 21 days
after receiving the additional information , if the i nformation is
submitted electronically, or 30 days after receiving the additional
information, if the information is not received electronically.
4. If [the approved] a claim approved pursuant to subsection 3
is not paid within [that] the period [,] specified in that subsection,
the organization for dental care shall pay interest on the claim in the
manner prescribed in subsection [1.] 2.
5. An organization for dental care shall not:
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the
claimant has already provided to the organization for dental care,
unless the organization for dental care provides a legitimate
reason for the request and the purpose of the request is not to
delay the payment of the claim, harass the claimant or discourage
the filing of claims.

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- 83rd Session (2025)
6. An organization for dental care shall not pay only part of a
claim that has been approved and is fully payable.
7. A court shall award costs and reasonable attorney’s fees to
the prevailing party in an action brought pursuant to this section.
8. 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 organization for dental care.
9. The Commissioner may require an organization for dental
care to provide evidence which demonstrates that the organization
for dental care has substantially complied with the requirements
set fort h in this section, including, without limitation, payment
within the time periods specified by this section of at least 95
percent of approved claims or at least 90 percent of the total dollar
amount for approved claims.
10. If the Commissioner determine s that an organization for
dental care is not in substantial compliance with the requirements
set forth in this section or has failed to approve or deny a claim or
pay an approved claim within 60 working days after receiving the
claim, the Commissioner may require the organization for dental
care to pay an administrative fine in an amount to be determined
by the Commissioner. Upon a second or subsequent determination
that an organization for dental care is not in substantial
compliance with the requirements set forth in this section or has
failed to approve or deny a claim or pay an approved claim within
60 working days after receiving the claim, the Commissioner may
suspend or revoke the certificate of authority of the organization
for dental care.
11. On or before February 1 of each year, an organization
for dental care shall submit to the Commissioner a report
concerning the compliance of the organization for dental care
with the requirements of this section during the immediately
preceding calendar year . The report must include, without
limitation:
(a) The number of claims for which the organization for
dental care failed to comply with the requirements of subsections 1
and 3 during the immediately preceding calendar year; and
(b) The total amount of interest paid by the organization for
dental care pursuant to subsections 2 and 4 during the
immediately preceding calendar year.

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- 83rd Session (2025)
Sec. 15. Chapter 695F of NRS is hereby amended by adding
thereto a new section to read as follows:
1. If a prepaid limited health service organization denies a
claim, the prepaid limited health service organization shall notify
the claimant in writing of the denial within:
(a) Twenty-one days after the prepaid limited health service
organization receives all information necessary to make a
determination concerning the claim , if the information is
submitted electronically; or
(b) Thirty days after the prepaid limited health organization
receives all information necessary to make a det ermination
concerning the claim, if the information is not submitted
electronically.
2. The notice required pursuant to subsection 1 must include,
without limitation:
(a) All reasons for denying the claim , including, without
limitation, the specific fac ts and provisions of the evidence of
coverage relied upon by the prepaid limited health organization as
a basis to deny the claim;
(b) The criteria by which the prepaid limited health service
organization determines whether to approve or deny the claim and
a description of the manner in which the prepaid limited health
service organization applied those criteria to the claim; and
(c) A summary of any applicable process established pursuant
to NRS 687B.820 for challenging the denial of the claim.
Sec. 16. Chapter 695G of NRS is hereby amended by adding
thereto a new section to read as follows:
1. Except as otherwise provided in subsection 2 and NRS
439B.754, a managed care organization shall approve or deny a
claim within 21 days after the managed care organization receives
the claim, if the claim is submitted electronically, or 30 days after
the managed care organization receives the claim, if the claim is
not submitted electronically. If the claim is approved, the managed
care organization shall also pay the claim within that period.
Except as otherwise provided in this section, if the approved claim
is not paid within that period, the managed care organization shall
pay interest on the claim at a rate of 10 percent per annum. The
interest must be calculated from the date on which payment of the
claim is due pursuant to this subsection until the date on which
the claim is paid.
2. If the managed care organization requires additional
information to determine whether to approve or deny the claim, it
shall notify the claimant of its request for the additional

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information within 20 working days after it receives the claim. The
managed care organization shall notify the claimant of all the
specific reasons for the delay in approving or denying the claim.
The managed care organization shall approve or deny the claim
within 21 days after receiving the additional information, if the
additional information is submitted electronically, or 30 days after
receiving the additional information, if the additional information
is not submitted electronically. If the claim is approved, the
managed care organization shall also pay the claim within that
period. If the approved claim is not paid within that period, the
managed care organiz ation shall pay interest on the claim in the
manner prescribed in subsection 1.
3. A managed care organization shall not:
(a) Deny a claim without a reasonable basis for the denial.
(b) Request a claimant to resubmit information that the
claimant has a lready provided to the managed care organization,
unless the managed care organization provides a legitimate reason
for the request and the purpose of the request is not to delay the
payment of the claim, harass the claimant or discourage the filing
of claims.
4. A managed care organization shall not pay only part of a
claim that has been approved and is fully payable.
5. A court shall award costs and reasonable attorney’s fees to
the prevailing party in an action brought pursuant to this section.
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 managed care organization.
7. The Commissione r may require a managed care
organization to provide evidence which demonstrates that the
managed care organization has substantially complied with the
requirements set forth in this section, including, without
limitation, payment within the time periods s pecified by this
section of at least 95 percent of approved claims or at least 90
percent of the total dollar amount for approved claims.
8. If the Commissioner determines that a managed care
organization is not in substantial compliance with the
requirements set forth in this section or has failed to approve or
deny a claim or pay an approved claim within 60 working days
after receiving the claim, the Commissioner may require the
managed care organization to pay an administrative fine in an
amount to be determined by the Commissioner. Upon a second or
subsequent determination that a managed care organization is not

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in substantial compliance with the requirements set forth in this
section or has failed to approve or deny a claim or pay an
approved claim wi thin 60 working days after receiving the claim,
the Commissioner may suspend or revoke the certificate of
authority of the managed care organization.
9. On or before February 1 of each year, a managed care
organization shall submit to the Commissioner a report
concerning the compliance of the managed care organization with
the requirements of this section during the immediately preceding
calendar year. The report must include, without limitation:
(a) The number of clai ms for which the managed care
organization failed to comply with the requirements of subsections
1 and 2 during the immediately preceding calendar year; and
(b) The total amount of interest paid by the managed care
organization pursuant to subsections 1 a nd 2 during the
immediately preceding calendar year.
Sec. 17. (Deleted by amendment.)
Sec. 17.5. NRS 695G.090 is hereby amended to read as
follows:
695G.090 1. Except as otherwise provided in subsection 3,
the provisions of this chapter apply to each organization and insurer
that operates as a managed care organization and may include,
without limitation, an insurer that issues a policy of health
insurance, an insurer that issues a policy of individual or group
health insurance, a carrier serving small employers, a fraternal
benefit society, a hospital or medical service corporation and a
health maintenance organization.
2. In addition to the provisions of this chapter, each manage d
care organization shall comply with:
(a) The provisions of chapter 686A of NRS, including all
obligations and remedies set forth therein; and
(b) Any other applicable provision of this title.
3. The provisions of NRS 695G.127, 695G.1639, 695G.164,
695G.1645, 695G.167 and 695G.200 to 695G.230, inclusive, and
section 16 of this act do not apply to a managed care organization
that provides health care services to recipients of Medicaid under
the State Plan for Medicaid or insurance pursuant to the Childr en’s
Health Insurance Program pursuant to a contract with the Division
of Health Care Financing and Policy of the Department of Health
and Human Services.
4. The provisions of NRS 695C.1735 , [and] 695G.1639 and
695G.230 and section 16 of this act do not apply to a managed care

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organization that provides health care services to members of the
Public Employees’ Benefits Program.
5. Subsections 3 and 4 do not exempt a managed care
organization from any provision of this chapter for services
provided pursuant to any other contract.
Sec. 18. NRS 695G.230 is hereby amended to read as follows:
695G.230 1. After approval by the Commissioner, each
health carrier shall provide a written notice to an insured, in clear
and comprehensible language that is understandable to an ordinary
layperson, explaining the right of the insured to file a written
complaint and to obtain an expedited review pursuant to NRS
695G.210. Such a notice must be provided to an insured:
(a) At the time the insured receives his or her certificate of
coverage or evidence of coverage;
(b) Any time that the health carrier denies coverage of a health
care service or limits coverage of a health care service to an insured;
and
(c) Any other time deemed necessary by the Commissioner.
2. If a health carrier denies coverage of a health care service to
an insured, including, without limitation, a [health maintenance ]
managed care organization that denies a claim related to a health
care plan pursuant to [NRS 695C.185, ] section 16 of this act, it
shall notify the insured and, if applicable, the provider of health
care who submitted the claim, in writing within :
(a) Twenty-one days after the health carrier receives all
information necessary to make a determi nation concerning the
claim, if the information is submitted electronically;
(b) Thirty days after the health carrier receives all information
necessary to make a determination concerning the claim, if the
information is not submitted electronically; or
(c) If no claim is received, within 10 working days after [it] the
health carrier denies coverage of the health care service . [of:]
3. The notice required pursuant to subsection 2 must include,
without limitation:
(a) [The reason] All reasons for denying coverage of the service
[;] , including, without limitation, the specific facts and provisions
of the plan relied upon by the health carrier as a basis to deny
coverage of the service;
(b) The criteria by which the health carrier or insurer determines
whether to authorize or deny coverage of the health care service [;]
and a description of the manner in which the health carrier
applied those criteria to the health care service;

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(c) A summary of any applicable process established pursuant
to NRS 687B.820 for challenging the denial of the claim;
(d) The right of the insured to:
(1) File a written complaint and the procedure for filing such
a complaint;
(2) Appeal an adverse determination pursuant to NRS
695G.241 to 695G.310, inclusive;
(3) Receive an expedited external review of an adverse
determination if the health carrier receives proof from the insured’s
provider of health care that failure to proceed in an expedited
manner may jeopardize the life or health of the insured, including
notification of the procedure for requesting the expedited external
review; and
(4) Receive assistance from any person, including an
attorney, for an external review of an adverse determination; and
[(d)] (e) The telephone number of the Office for Consumer
Health Assistance.
[3.] 4. A written notice which is approved by the
Commissioner pursuant to subsection 1 shall be deemed to be in
clear and comprehensible language that is understandable to an
ordinary layperson.
5. If a health carrier denies a claim submitted by a provider
of health care, the health carrier shall notify the provider of health
care in writing of the denial within:
(a) Twenty-one days after the health carrier receives all
information necessary to make a determination concerning the
claim, if the information is submitted electronically; or
(b) Thirty days after the health carrier receives all information
necessary to make a determination concerning the claim, if the
information is not submitted electronically.
6. The notice required pursuant to subsection 5 must include,
without limitation:
(a) All reasons for denying the claim , including, without
limitation, the specific facts and provisions of the plan relied upon
by the health carrier as a basis to deny coverage of the service;
(b) The criteria by which the health carrier determines
whether to approve or deny the claim and a description of the
manner in which the health carrier applied those criteria to the
claim; and
(c) A summary of any applicable process established p ursuant
to NRS 687B.820 for challenging the denial of the claim.

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Sec. 18.5. NRS 287.04335 is hereby amended to read as
follows:
287.04335 If the Board provides health insurance through a
plan of self -insurance, it shall comply with the provisions of
NRS 439.581 to 439.597, inclusive, 686A.135, 687B.352,
687B.409, 687B.692, 687B.723, 687B.725, 687B.805, 689B.0353,
[689B.255,] 695C.1723, 695G.150, 695G.155, 695G.160,
695G.162, 695G.1635, 695G.164, 695G.1645, 695G.1665,
695G.167, 695G.1675, 695G.170 to 695G.1712, inclusive,
695G.1714 to 695G.174, inclusive, 695G.176, 695G.177, 695G.200
[to 695G.230, inclusive] , 695G.210, 695G.2 20, 695G.241 to
695G.310, inclusive, 695G.405 and 695G.415, in the same manner
as an insurer that is licensed pursuant to title 57 of NRS is required
to comply with those provisions.
Secs. 19-22. (Deleted by amendment.)
Sec. 23. 1. The amendatory provisions of this act do not
supersede the provisions of any contract entered into or policy
issued before January 1, 2026, but apply to any renewal of such a
contract or policy.
2. The amendatory provisions of this act do not apply to any
claim under a policy of health insurance or other program that
provides health coverage submitted before January 1, 2026, but,
except as otherwise provided in subsection 1, apply to such claims
submitted on or after that date.
Sec. 24. (Deleted by amendment.)
Sec. 25. NRS 695C.128 are 695C.185 are hereby repealed.
Sec. 26. This act becomes effective on January 1, 2026.

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