# Nev. Rev. Stat. § 695G.012: “Adverse determination” defined

> Nevada · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.012

## Section

- **Citation:** Nev. Rev. Stat. § 695G.012
- **Heading:** “Adverse determination” defined
- **Jurisdiction:** Nevada
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** NV Code / Title 57 / Chapter 695G / Section 695G.012

## Text

“ Adverse determination ” means a determination by a health carrier or utilization review organization that an admission, availability of care, continued stay or other health care service that is a covered benefit has been reviewed and, based upon the information provided, does not meet the health carrier's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service or payment for the service is therefore denied, reduced or terminated.

## Nearby sections

- [Nev. Rev. Stat. § 695G.010 Definitions](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.010.md)
- [Nev. Rev. Stat. § 695G.012 “Adverse determination” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.012.md)
- [Nev. Rev. Stat. § 695G.014 “Authorized representative” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.014.md)
- [Nev. Rev. Stat. § 695G.015 “Benefits” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.015.md)
- [Nev. Rev. Stat. § 695G.016 “Clinical peer” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.016.md)
- [Nev. Rev. Stat. § 695G.017 “Covered person” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.017.md)
- [Nev. Rev. Stat. § 695G.019 “Health benefit plan” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.019.md)
- [Nev. Rev. Stat. § 695G.020 “Health care plan” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.020.md)
- [Nev. Rev. Stat. § 695G.022 “Health care services” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.022.md)
- [Nev. Rev. Stat. § 695G.024 “Health carrier” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.024.md)
- [Nev. Rev. Stat. § 695G.026 “Independent review organization” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.026.md)
- [Nev. Rev. Stat. § 695G.030 “Insured” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.030.md)
- [Nev. Rev. Stat. § 695G.040 “Managed care” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.040.md)
- [Nev. Rev. Stat. § 695G.050 “Managed care organization” defined](https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.050.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_NV_T57_C695G_S695G.012. Check the current official text before relying on it. Not legal advice.