Health Insurance Claims: Official Guidance on New Requirements for Timely Processing and Payment
The Nevada Division of Insurance is providing this webpage as a centralized resource for information on new requirements related to the submission, processing, and payment of health insurance claims. These provisions were enacted under Assembly Bill 52, passed during the 83rd Session of the Nevada Legislature (2025), and apply to most private health insurance plans issued or delivered in the state.
The new law amends specific deadlines for the submission and payment of claims, with distinctions between electronic and paper formats. Health insurers, third-party administrators, and health care providers must comply with these updated standards.
This page is the official notice, as mandated by Assembly Bill 52, from the Nevada Division of Insurance regarding new and amended statutory requirements for the submission, processing, and payment of health insurance claims in Nevada. These requirements were established by legislation passed during the 83rd Session of the Nevada Legislature (2025) and are codified under 683A.0879, 687B.730, 687B.820, 689A.410, 689A.755, 689B.0295, 689B.255, 689C.335, 695A.188, 695B.2505, 695B.400, 695D.215, 695G.230, and Sections 15 and 16 of the enacting legislation.
This page will be updated as necessary to reflect future legislative, regulatory, or implementation developments.
View the text of Assembly Bill 52 (2025 Session):
AB52 Text
Key Implementation Requirements
Providers, third-party administrators, and insurers must comply with the following specific provisions:
1. Processing and Payment Deadlines
21 calendar days to approve or deny a claim submitted electronically.
30 calendar days to approve or deny a claim submitted by mail or other non-electronic means.
Payment timeframe and approval timeframe overlap: approved claims must be paid within the applicable 21- or 30-day period after the claim was received.
2. Requests for Additional Information
Insurers and third-party administrators must request the required additional information within 20 working days of receiving the claim.
- After receiving additional information, insurers and third-party administrators must reprocess the claim and pay within 21 days (electronic) or 30 days (non-electronic).
3. Limits on Unreasonable or Duplicate Requests
Insurers and third-party administrators must not request resubmission of documentation that was already provided unless there is a legitimate reason, and this cannot be used to delay payment unnecessarily.
4. Requirements When Denying a Claim
Claims may not be denied without a reasonable basis.
Denial notices must be issued within 21 calendar days (electronic submissions) or 30 calendar days (paper/non-electronic) after receipt of all required information.
Notices must include:
A clear explanation of the denial reason.
The criteria for which a claim was denied, and how the criteria were applied.
Appeal or dispute resolution instructions.
5. Provider and Consumer Notifications
Carriers must provide annual notices to participating providers and covered individuals, explaining claims payment procedures as required under NRS 687B.730.
Carriers must have a formal process for providers to challenge denied claims.
6. Interest and Penalties
If insurers or third-party administrators fail to pay claims within statutory timeframes, interest accrues from the payment due date until paid.
The Division may impose administrative penalties for violations of the provisions of this law or for failure to approve or deny any claim within a 60-working-day deadline.
For repeat noncompliance, the Division may suspend or revoke the insurer’s certificate of authority or the third-party administrator’s certificate of registration.
7. Annual Reporting and Enforcement
Insurers and third-party administrators must submit annual compliance reports to the Nevada Division of Insurance documenting adherence to deadlines and claim handling metrics starting on or before February 1, 2027, for the 2026 calendar year. SERFF, the System for Electronic Rate and Form Filings, will be used for this purpose.
The Division reserves the right to audit and enforce standards.
8. Support for Small or New Providers
A Provider Resource Program is established to assist small or newly established health care practices with:
Understanding the reimbursement process and legal obligations around claims.
Navigating insurer challenges and dispute mechanisms.
9. Consumer Protections
Insured individuals have the right to:
Receive timely and clear explanations about claim decisions.
Appeal or challenge denied claims.
File complaints with the Division if insurers fail to comply.
Consumer Impact
The updates under Assembly Bill 52 are designed to improve the experience of insured individuals by establishing clearer, faster standards for how health insurance claims are handled. The bill requires insurers to acknowledge, process, and pay claims within defined timeframes, with interest penalties applied to late payments. These changes help ensure Nevadans receive more timely responses to their medical claims, reducing administrative frustration for both patients and providers. By minimizing reimbursement delays and supporting better care coordination, the law also promotes greater transparency and accountability in how insurance coverage operates.