Procedures for resolution of disputes; exemptions.

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, without limitation, an efficient process by which a 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 contract with the Nevada Health Authority; 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. (Added to NRS by 2017, 2353; A 2025, 2393)