1. 1. Except as otherwise provided in subsection 3, an organization for dental care shall approve or deny a claim relating to a plan for dental care and, if the organization for dental care:

   1. (a) Approves the claim, pay the claim within:

      1. (1) Twenty-one days after the organization for dental care receives the claim, if the claim is submitted electronically; or
      2. (2) Thirty days after the organization for dental care receives the claim, if the claim is not submitted electronically.

   2. (b) Denies the claim, notify the claimant in writing of the denial within 21 days after the organization for dental care receives the claim, if the claim was submitted electronically, or 30 days after the organization for dental care receives the claim, if the claim was not submitted electronically. The notice must include, without limitation:

      1. (1) All reasons for denying the claim, including, without limitation, the specific facts and provisions of the plan relied upon by the organization for dental care as a basis to deny the claim;
      2. (2) The criteria by which the organization for dental care determines whether to approve or deny the claim and a description of the manner in which the organization for dental care applied those criteria to the claim; and
      3. (3) A summary of any applicable process established pursuant to NRS 687B.820 for challenging the denial of the claim.
2. 2. Except as otherwise provided in this section, if the approved claim is not paid within the period specified by subsection 1, the organization for dental care shall pay interest on the claim at the rate of 10 percent per annum. The interest must be calculated from the date the payment of the claim is due pursuant to subsection 1 until the claim is paid.

3. 3. If the organization for dental care requires additional information to determine whether to approve or deny the claim, it shall notify the claimant of its request for the additional information within 20 working days after it receives the claim. The organization for dental care shall notify the claimant of the reason for the delay in approving or denying the claim. The organization for dental care shall approve or deny the claim and, if the organization for dental care:

   1. (a) Approves the claim, pay the claim within:

      1. (1) Twenty-one days after receiving the additional information, if the information is submitted electronically; or
      2. (2) Thirty days after receiving the additional information, if the information is not submitted electronically.
   2. (b) Denies the claim, provide notice of the denial in the manner prescribed in paragraph (b) of subsection 1 within 21 days after receiving the additional information, if the information is submitted electronically, or 30 days after receiving the additional information, if the information is not received electronically.
4. 4. If a claim approved pursuant to subsection 3 is not paid within the period specified in that subsection, the organization for dental care shall pay interest on the claim in the manner prescribed in subsection 2.

5. 5. An organization for dental care shall not:

   1. (a) Deny a claim without a reasonable basis for the denial.
   2. (b) Request a claimant to resubmit information that the claimant has already provided to the organization for dental care, unless the organization for dental care provides a legitimate reason for the request and the purpose of the request is not to delay the payment of the claim, harass the claimant or discourage the filing of claims.
6. 6. An organization for dental care shall not pay only part of a claim that has been approved and is fully payable.
7. 7. A court shall award costs and reasonable attorney’s fees to the prevailing party in an action brought pursuant to this section.
8. 8. The payment of interest provided for in this section for the late payment of an approved claim may be waived only if the payment was delayed because of an act of God or another cause beyond the control of the organization for dental care.
9. 9. The Commissioner may require an organization for dental care to provide evidence which demonstrates that the organization for dental care has substantially complied with the requirements set forth in this section, including, without limitation, payment within the time periods specified by this section of at least 95 percent of approved claims or at least 90 percent of the total dollar amount for approved claims.
10. 10. If the Commissioner determines that an organization for dental care is not in substantial compliance with the requirements set forth in this section or has failed to approve or deny a claim or pay an approved claim within 60 working days after receiving the claim, the Commissioner may require the organization for dental care to pay an administrative fine in an amount to be determined by the Commissioner. Upon a second or subsequent determination that an organization for dental care is not in substantial compliance with the requirements set forth in this section or has failed to approve or deny a claim or pay an approved claim within 60 working days after receiving the claim, the Commissioner may suspend or revoke the certificate of authority of the organization for dental care.

11. 11. On or before February 1 of each year, an organization for dental care shall submit to the Commissioner a report concerning the compliance of the organization for dental care with the requirements of this section during the immediately preceding calendar year. The report must include, without limitation:

    1. (a) The number of claims for which the organization for dental care failed to comply with the requirements of subsections 1 and 3 during the immediately preceding calendar year; and
    2. (b) The total amount of interest paid by the organization for dental care pursuant to subsections 2 and 4 during the immediately preceding calendar year.

(Added to NRS by 1991, 1332; A 2025, 2405)