Medical Billing and Revenue Cycle Management Built for Nevada Practices

Yes, it's AB 469, and it's codified at NRS 439B.700 through 439B.760. The law sets up an arbitration process for emergency claims that fall outside a patient's standard payer network, so patients aren't stuck with a massive out of network bill after an emergency they didn't choose. For practices, the important part is the process itself. There's a specific sequence for submitting these claims and pursuing arbitration if the payer disputes the amount, and missing a step in that sequence is one of the most common reasons an otherwise valid emergency claim ends up sitting unpaid for months.

Nevada's prompt pay law, NRS 683A.0594, requires insurers to pay a clean electronic claim within 30 days of receipt. The word clean is doing a lot of work in that sentence though. If a claim has an error, a missing modifier, or incomplete documentation, that 30-day clock doesn't really protect you, because the payer can simply deny or pend it and the timeline resets once you resubmit. That's exactly why getting a claim right the first time matters so much more in Nevada than in states without this kind of statute.

Yes, and this is genuinely one of the more complicated parts of billing in this state. Nevada Medicaid runs through five separate managed care organizations, Anthem BCBS Healthcare Solutions, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan, and CareSource, and each one has its own prior authorization requirements and its own preferences around modifiers. We stay current on all five, and we check every submission against the current Nevada Medicaid Services Manual and Known Issues list before it goes out, not after it bounces back.

Yes, and if your practice sees patients from Las Vegas's hospitality and gaming industry, this matters more than you might think. The Culinary Health Fund covers more than 130,000 members in the Las Vegas area, and its billing rules differ from standard commercial insurance in ways that trip up billers who don't work with the plan regularly. We handle Culinary Health Fund claims often enough to know its specific documentation and authorization requirements without having to look them up every time.

No, and honestly this is one of the bigger gaps we see in this industry. A lot of billing companies focus entirely on Clark and Washoe County and treat rural Nevada as an afterthought. We work with practices across the state, including clinics in Nye, Elko, Churchill, Humboldt, Lyon, and Douglas counties, where fee for service Medicaid, FQHC billing, and sliding fee schedules are the norm rather than the exception. It's a genuinely different kind of billing work, and we built our processes to handle both sides of that divide well.

Most billing companies, us included, charge a percentage of collections rather than a flat monthly fee, and that percentage typically falls somewhere between 4% and 9% depending on your specialty, your claim volume, and how much of the revenue cycle you're outsourcing. A single provider primary care practice usually lands toward the lower end of that range, while high complexity specialties like oncology or cardiology tend to sit higher because of the added coding and prior authorization work involved. We give you an actual number during the free audit, based on your real claim history, rather than a generic industry range.