Approval or denial of claims; payment of claims and interest; requests for additional information; award of costs and attorneys fees; compliance with requirements; imposition of administrative fine or suspension or revocation of certificate of authority for failure to comply; report of compliance by corporation.

Nev. Rev. Stat. § 695B.2505

in effect

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 that period. Except as otherwise provided in this section, if the approved claim is not paid within that period, the corporation shall pay interest on the claim at a rate of 10 percent per annum. The interest must be calculated from the date on which the payment of the claim is 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 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 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: (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. 4. A corporation shall not pay only part of a claim that has been approved and is fully payable. 5. A court shall award costs and reasonable attorneys 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 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 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. 8. If the Commissioner determines 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 corporation 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.

Source: NV Statutes (Official Site)URL: https://www.leg.state.nv.us/nrs/NRS-695B.htmlFetched: 10/4/2026