695G.080 - “Utilization review” defined.
695G.080 “Utilization review” defined.
1. “Utilization review” means the various methods that may be used by a managed care organization to review the amount and appropriateness of the provision of a specific health care service to an insured.
2. The term does not include an external review of a final adverse determination conducted pursuant to NRS 695G.241 to 695G.310, inclusive.
(Added to NRS by 1997, 302; A 2003, 783)