This article covers Nevada workers' compensation medical billing requirements, including deadlines, EOB requirements, and insurer liability for unauthorized services.
Billing Information & Timeliness
Explanation of Benefits (EOB) - Requirements
Prior Authorization - Insurer Liability without Written Authorization
Providers can see here for the 2026 Nevada Workers' Compensation Medical Fee Schedule, effective February 1, 2026.
Billing Information & Timeliness
Reimbursement is based on the appropriate coding of health care services provided as documented in the medical record.
Bills for health care services must be submitted within 90 days after the date on which the services were rendered unless good cause is shown for a later billing.
In no event may an initial bill or request for reconsideration for healthcare services be submitted later than 12 months after the date on which the services were rendered unless claim acceptance is delayed beyond 12 months because of claim litigation. Reimbursement for healthcare services is determined by the Nevada Medical Fee Schedule in effect at the time of the date of service.
The insurer or a representative of the insurer may require the submission of reports on the injured employee’s admission to, and discharge from, the hospital and all physicians’ or chiropractors’ medical reports before payment of a hospital or medical bill.
An insurer shall pay or deny reimbursement of charges pursuant to NRS 616C.136 after receipt by the insurer or his agent of the first bill for those charges unless good cause is shown for a later payment or denial.
Bills received erroneously should be returned to the health care provider with an explanation.
Emergency Services
Any physician or chiropractor who is called upon to render service in the case of an emergency or severe trauma as a result of an industrial injury may use whatever resources and techniques are necessary to cope with the situation.
The treatment of injured employees in such situations is not restricted to physicians and chiropractors that are members of the Treating Panel of Physicians and Chiropractors established by the Administrator pursuant to NRS 616C.090 or have contracted with an insurer or an organization for managed care to provide health care services to injured employees.
A provider of health care shall, within 14 days after the date on which services are rendered or the injured employee is discharged from the hospital, unless good cause is shown, submit to an insurer, a third-party administrator or an organization for managed care, a report on the services rendered.
This subsection does not require the disclosure of any information prohibited by state or federal statute or regulation.
Explanation of Benefits (EOB) - Requirements
The insurer shall provide an Explanation of Benefits (EOB) for each code billed to include the amounts for services that are paid and the amounts that are reduced or disallowed. Indicate on each payment those services, which are being reduced or disallowed, and the reasons for the reduction or disallowance.
The EOB must include notification to the provider of health care that within 60 days after receiving the notice of denial or reduction, they can submit a written request to the State of Nevada, Division of Industrial Relations, Workers’ Compensation Section for a review of that action.
Incorrect Billing Codes
If a bill submitted to the insurer by a provider of health care requires an adjustment because the codes set forth in the bill are incorrect, the insurer shall:
(1) Process and pay or deny payment of that portion of the bill, if any, that contains correct codes.
(2) Return the bill to the provider of health care and request additional information or documentation concerning that portion of the bill relating to the incorrect codes; and
(3) Pay or deny payment within 20 days after receipt by the insurer or the insurer’s agent of the resubmitted bill with the additional information or documentation.
Unlisted Codes
For services which reimbursement has not been established by the Nevada Medical Fee Schedule or adopted resources, it is recommended that the insurer and provider mutually agree on reimbursement before the services are provided.
NAC 616C.143 addresses payment for consultation and treatment provided outside this State.
Prior Authorization - Insurer Liability without Written Authorization
If there is no prior written authorization that payment for the consultation or treatment will be made in accordance with the schedule of reasonable fees and charges allowable for accident benefits adopted for this State pursuant to NRS 616C.260, unless otherwise provided in contract between the provider of health care and the insurer, the insurer is solely responsible for the payment of all services rendered.
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