Nevada § 616A.469 - Certificate to operate as independent review organization: Authority of Commissioner to issue certificate; application; fee; prerequisites to issuance; ineligible parties

§ 616A.469. Certificate to operate as independent review organization: Authority of Commissioner to issue certificate; application; fee; prerequisites to issuance; ineligible parties

1. The Commissioner may issue certificates authorizing qualified independent review

organizations to conduct external reviews for the purposes of chapters 616A to 617,

inclusive, of NRS. If the Commissioner issues such certificates and the Commissioner determines that

an independent review organization is qualified to conduct external reviews for the

purposes of chapters 616A to 617, inclusive, of NRS, the Commissioner shall issue

a certificate to the independent review organization that authorizes the organization

to conduct such external reviews in accordance with the provisions of NRS 616C.363 and the regulations adopted by the Commissioner. 2. The Commissioner may adopt regulations setting forth the procedures that an independent

review organization must follow to be issued a certificate to conduct external reviews. Any regulations adopted pursuant to this section must include, without limitation,

provisions setting forth: (a) The manner in which an independent review organization may apply for a certificate

and the requirements for the issuance and renewal of the certificate pursuant to this

section; (b) The grounds for which the Commissioner may refuse to issue, suspend, revoke or

refuse to renew a certificate issued pursuant to this section; (c) The manner and circumstances under which an independent review organization is

required to conduct its business; and (d) Any applicable fees for issuing or renewing a certificate of an independent review

organization pursuant to this section. 3. A certificate issued pursuant to this section expires 1 year after it is issued

and may be renewed in accordance with regulations adopted by the Commissioner. 4. Before the Commissioner may issue a certificate to an independent review organization,

the independent review organization must: (a) Demonstrate to the satisfaction of the Commissioner that it is able to carry out,

in a timely manner, the duties of an independent review organization as set forth

in NRS 616C.363 and the regulations adopted by the Commissioner. The demonstration must include, without limitation, proof that the independent review

organization employs, contracts with or otherwise retains only persons who are qualified

because of their education, training, professional licensing and experience to perform

the duties assigned to those persons; and (b) Provide assurances satisfactory to the Commissioner that the independent review

organization will: (1) Conduct external reviews in accordance with the provisions of NRS 616C.363 and the regulations adopted by the Commissioner; (2) Render its decisions in a clear, consistent, thorough and timely manner; and (3) Avoid conflicts of interest. 5. For the purposes of this section, an independent review organization has a conflict

of interest if the independent review organization or any employee, agent or contractor

of the independent review organization who conducts an external review has a professional,

familial or financial interest of a material nature with respect to any person who

has a substantial interest in the outcome of the external review, including, without

limitation: (a) The claimant; (b) The employer; or (c) The insurer or any officer, director or management employee of the insurer. 6. The Commissioner shall not issue a certificate to an independent review organization

that is affiliated with: (a) 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; (b) An insurer; (c) A third-party administrator; or (d) A national, state or local trade association. 7. An independent review organization which is certified or accredited by an accrediting

body that is nationally recognized shall be deemed to have satisfied all the conditions

and qualifications required for the independent review organization to be issued a

certificate pursuant to this section.