616C.157 - Request for prior authorization: Time to respond; effect of failure to respond in timely manner.
616C.157 Request for prior authorization: Time to respond; effect of failure to respond in timely manner.
1. An insurer, organization for managed care or third-party administrator shall respond to a written request for prior authorization for:
(a) Treatment;
(b) Diagnostic testing; or
(c) Consultation,
Ê within 5 working days after receiving the written request.
2. If the insurer, organization for managed care or third-party administrator fails to respond to such a request within 5 working days, authorization shall be deemed to be given. The insurer, organization for managed care or third-party administrator may subsequently deny authorization.
3. If the insurer, organization for managed care or third-party administrator subsequently denies a request for authorization submitted by a provider of health care for additional visits or treatments, it shall pay for the additional visits or treatments actually provided to the injured employee, up to the number of treatments for which payment is requested by the provider of health care before the denial of authorization is received by the provider.
(Added to NRS by 1999, 2214)