Application for initial issuance of certificate: Generally.

Except as otherwise provided in NAC 616A.610 , an external review organization applying for the initial issuance of a certificate to conduct external reviews must submit to the Commissioner, on a form prescribed by the Commissioner, an application in writing and must provide to the Commissioner at the time of application: 1. A written statement that identifies: (a) The number of external reviewers that the external review organization employs, contracts with or otherwise retains to conduct external reviews; (b) The specialty of each external reviewer; (c) Whether each external reviewer is certified by the entity that regulates his or her specialty; and (d) The schedule of fees that the external review organization will charge to conduct an external review. 2. A written summary of the procedures that the external review organization will use to: (a) Ensure that an external reviewer employed, contracted with or otherwise retained by the external review organization is qualified to conduct a specific external review; (b) Ensure that the external review organization and any employee, agent or contractor of the external review organization does not have a conflict of interest as set forth in NRS 616A.469 ; and (c) Submit a copy of the determination regarding an external review to each party to the external review. 3. A written affidavit that: (a) The information contained in the application and any accompanying materials are complete and correct; (b) The external review organization will conduct external reviews in accordance with NRS 616A.469 and 616C.363 ; (c) The external review organization and any employee, agent or contractor of the external review organization will avoid a conflict of interest as set forth in NRS 616A.469 ; and (d) The external review organization is not affiliated with: (1) An organization for managed care which provides comprehensive medical and health care services to employees for injuries or diseases pursuant to chapters 616A to 617 , inclusive, of NRS; (2) An insurer; (3) A third-party administrator; or (4) A national, state or local trade association. 4. All applicable fees required, including, without limitation, all applicable fees required pursuant to NAC 616A.640 , for the initial issuance of a certificate to conduct external reviews.