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Nevada bill would require insurers to respond to Medicaid third‑party claims within 60 days to comply with federal law
Summary
Senate Bill 9 would revise Nevada law to conform with the Consolidated Appropriations Act, 2022, requiring insurers to respond to state agency inquiries about third‑party liability claims within 60 days and to not deny claims solely for lack of prior authorization when the state has authorized the service.
Senate Bill 9 would change state law so insurers that cover Medicaid eligibles must respond to a state agency’s inquiry about payment for a medical claim within 60 days and may not deny a state‑submitted claim solely for lack of prior authorization when the state authorized the service.
The measure was presented to the Nevada Assembly Committee on Health and Human Services by representatives of the Division of Healthcare Financing and Policy, who said the bill implements two provisions of federal law enacted in the Consolidated Appropriations Act of 2022.
Cynthia Leach, agency manager for the Division of Healthcare Financing and Policy overseeing compliance and program integrity, told the committee that "Medicaid is generally the payer of last resort. When Medicaid beneficiaries have additional health care coverage, third party liability rules govern the legal obligation of third party payers." Leach said section 202 of the Consolidated Appropriations Act of 2022 revised two requirements: insurers must respond to an inquiry about a claim "no later than 60 days after receiving the inquiry," and insurers may not deny a state’s claim solely for lack of prior authorization when the state authorized the item or service.
Leach said the bill "increases Nevada's flexibility to identify and obtain prompt payment from third party resources that are legally responsible to pay claims primary to Medicaid." Stacy Weeks of the Division of Healthcare Financing and Policy introduced the presenters to the committee.
Committee members asked clarifying questions about the 60‑day requirement. The chair asked whether the 60‑day timeline applies specifically to Medicaid payments; Leach confirmed it does. One member asked whether the 60 days was intended as a "prompt pay" requirement; Leach characterized the change as a prompt‑payment expectation for third parties.
No public testimony was offered in support, opposition or neutral positions during the hearing on SB 9, and the presenters closed without further comment. The committee did not record any motion or formal vote during the portion of the transcript provided.
Why it matters: The bill would align Nevada statute with federal mandates that aim to speed recovery of payment from other liable insurers before Medicaid pays. The state’s implementation could affect billing and authorization workflows for insurers, state staff and providers who submit claims on behalf of Medicaid beneficiaries.
What's next: The committee opened and closed the hearing on SB 9 during the session; no vote or amendment is recorded in the provided transcript.
