Current through 82nd (2023) Legislative Session Chapter 535 and 34th (2023) Special Session Chapter 1 and 35th (2023) Special Session Chapter 1
Section 695G.280 - Basis for decision of independent review organization The decision of an independent review organization concerning a request for an external review must be based on:
1. Documentary evidence, including any recommendation of the physician of the insured submitted pursuant to NRS 695G.251;2. Medical or scientific evidence, including, without limitation:(a) Professional standards of safety and effectiveness for diagnosis, care and treatment that are generally recognized in the United States;(b) Any report published in literature that is peer-reviewed;(c) Evidence-based medicine, including, without limitation, reports and guidelines that are published by professional organizations that are recognized nationally and that include supporting scientific data; and(d) An opinion of an independent physician who, as determined by the independent review organization, is an expert in the health specialty that is the subject of the independent review; and3. The terms and conditions for benefits set forth in the evidence of coverage issued to the insured by the health carrier.Added to NRS by 2003, 782; A 2011, 3414Added to NRS by 2003, 782; A 2011, 3414