In a significant move aimed at enhancing transparency and efficiency in the health insurance claims process, the Nevada State Legislature has introduced Assembly Bill 52 (AB52) on April 24, 2025. This bill seeks to address longstanding frustrations among healthcare providers and patients regarding the approval and payment of insurance claims.

AB52 primarily focuses on establishing clearer guidelines for insurance carriers in handling claims. Key provisions include a requirement for carriers to provide detailed criteria for claim approvals or denials, along with a summary of processes available for challenging denied claims. This transparency is intended to empower claimants by ensuring they understand the basis for decisions made by their insurance providers.

One of the most notable aspects of the bill is its stipulation regarding payment timelines. If a claim is approved but not paid within the specified period, carriers will be mandated to pay interest on the claim at a rate of 10 percent per annum. This provision aims to incentivize timely payments and reduce the financial burden on healthcare providers who often face delays in receiving compensation for their services.

The bill also addresses the issue of information requests from carriers. It mandates that if additional information is needed to process a claim, insurers must notify claimants within 20 working days. Furthermore, carriers are prohibited from denying claims without a reasonable basis and from requesting previously submitted information without legitimate justification. These measures are designed to prevent unnecessary delays and ensure a fair claims process.

While AB52 has garnered support from various healthcare advocacy groups, it has also faced opposition from some insurance industry representatives who argue that the bill could lead to increased operational costs and potential litigation. Critics express concerns that the stringent requirements may overwhelm smaller insurance providers, potentially leading to higher premiums for consumers.

The implications of AB52 extend beyond the immediate claims process. By fostering a more transparent and accountable system, the bill could enhance trust between healthcare providers and insurers, ultimately benefiting patients through improved access to care. Experts suggest that if passed, the legislation could serve as a model for other states grappling with similar issues in the healthcare insurance landscape.

As the legislative session progresses, stakeholders will be closely monitoring the bill's developments, with discussions likely to continue around its potential economic and social impacts. The outcome of AB52 could reshape the dynamics of health insurance claims in Nevada, setting a precedent for future reforms in the industry.