Prompt Pay Statutes Prompt Pay Statutes and Regulationsand ...

[Pages:8]State

Alabama Alaska Arizona Arkansas California

Colorado Connecticut

Prompt Pay Statutes and Regulations

Status/Terms of Law

Clean claims paid within 45 working days, applies to HMO's only.

State Contact

Alabama Dept. of Public Health (334) 206-5366

Website Address (If Available)



Clean claims must be paid within 30 working days.

Alaska Division of Insurance (907) 465-4607

y=/doc/{t8722}

Clean claims must be paid within 30 days or interest payments are required (usually about 10%). Clean, electronic claims must be paid or denied in 30 calendar days, paper in 45. 12% per annum interest after 60 days. Claims must be paid within 45 working days for an HMO, 30 days for other health service plans. Interest accrues at 15% per annum or $15 penalty, whichever is greater. Claims must be paid in 30 calendar days if submitted electronically, 45 if paper. 10% annual interest penalty. Claims must be paid within 45 days. Interest accrues at 15% per annum.

Arizona Dept. of Insurance (602) 912-8444

Arkansas Dept. of Insurance (501) 371-2766

California Dept. of Managed Health Care (800) 400-0815

Colorado Division of Insurance (303) 894-7499

Connecticut Dept. of Insurance (860) 297-3889

blications/timely_pay.pdf

ance

(Click on Insurance Laws, Rules, and Reg. #43) /library/statutes/knoxkeene/_Toc32032014

ado/lpext.dll?f=templates&f n=fs-main.htm&2.0

ew.asp?a=1267&q=25445 6

1

State

Delaware

Prompt Pay Statutes and Regulations

Status/Terms of Law

Clean claims must be paid in 30 days.

State Contact

Delaware Dept. of Insurance (302) 739-4251x123

Website Address (If Available)

Dist. of Columbia Florida Georgia

Clean claims will be paid in 30 days. Interest payable at 1.5% days 31-60, 2% days 61120, and 2.5% after 120 days. Applies to claims received on or after October 16, 2002. Clean HMO claims (paper or electronic) must be paid in 35 days, non-HMO in 45 days. Claims where information was requested must be paid in 120. Interest penalty is 10% per year. Statute # 31555 Claims must be paid within 15 working days. Interest accrues at 18% per annum.

Dist. Of Columbia Dept. of Insurance (202) 442-7786

Florida Dept. of Insurance, Health Insurance Division (850)-413-3132

Georgia Office of Insurance Comm. (404) 656-2164

Hawaii Idaho

Clean, paper claims must be paid in 30 days, electronic claims within 15 days. Interest accrues at 15% per annum. Commissioner may impose fines. Paper Claims Settled in 45 days & electronic Claims in 30 days ? Chapter 56.

Hawaii Medical Association (808) 536-7702

Idaho Dept. of Insurance (208) 334-4300

http:disr.news_room /2003/February/02_05_03. shtm#top

es/index.cfm?App_mode=Dis play_Statute&Search_String= &URL=Ch0627/SEC613.HTM &Title=->2002->Ch0627>Section%20613

gibin/gl_codes_detail.pl?code=3 3-24-59.5 state.hi.us



Illinois

Clean claims must be paid in 30 days. Interest accrues at 9% per annum.

Illinois Dept. of Insurance (217) 524-4051 (877) 527-9431 (toll free)

legis.state.il.us

Refer to Senate Bill 2511255-71a

2

State

Indiana Iowa Kansas Kentucky

Louisiana

Maine Maryland

Prompt Pay Statutes and Regulations

Status/Terms of Law

State Contact

Paper claims must be paid in Indiana Dept. of

45 day. Electronic claims must Insurance

be paid in 30 days.

(317) 232-2395

Website Address

(If Available)

h/payments.html

Payment to be made in 30 days. Penalty is 10% per annum.

Iowa Division of Insurance (515) 281-5523

Claims will be paid in 30 days. Kansas Dept. of

Interest accrues at a rate of Insurance

1% per month.

(785) 296-7826

Claims must be paid or denied within 30 calendar days. Interest accrues at 12% per annum when 31-60 days late, 18% 61-90 when days late and 21% when 91+ days late.

Kentucky Dept. of Insurance (800) 595-6053 X 4303

Claims submitted electronically must be paid within 25 days. If not paid within 25 days the health insurance issuer shall pay to the claimant an additional late payment adjustment equal to 1 percent of the unpaid balance due for each month.

Clean claims must be paid within 30 days. Interest accrues at 1.5% per month.

Louisiana Dept. of Insurance (225) 219-9524

Maine Bureau of Insurance (207) 624-8428

Clean claims must be paid within 30 days. Interest accrues at monthly rates of 1.5% (31-60 days late), 2% (61-120), and 2.5% (121+) respectively.

The Maryland State Medical Society (410) 539-0872

CODE/2001SUPPLEMENT/50 7B/4A.html

/cgi-bin/statutes/index.cgi

RS/30417A/CHAPTER.HTM

(Click .702 and .730)

ce_of_health/quality_mana gement/qm_reg74.htm

s/statutes/24-A/title24Asec2436.html maineinsurancereg.or g rs/billfile/hb0639.htm

(Click on House Bill 639)

3

State

Massachusetts

Prompt Pay Statutes and Regulations

Status/Terms of Law

MCL 500.2006 MCL 200.111

State Contact

Massachusetts Division of Insurance (617) 521-7347

Website Address (If Available)

Michigan

Minnesota Mississippi Missouri

A clean claim submitted to an insurance co. with all the correct information shall be paid within 45 days. Penalty is 12% interest. The bills also hold Medicaid and HMO's to this 45 day schedule. Clean claims must be paid in 30 days. Interest accrues at 1.5% per month if not paid or denied. Clean claims must be paid within 25 days if electronic, 35 days if paper claim. Interest accrues at 1.5% per month.

Michigan Dept. of Insurance (877)-999-6442

Minnesota Dept. of Health (651) 282-6327

Mississippi Dept. of Insurance (601) 359-3569

newswire/0,1607,7-1363452_3482-35876-M_2002_5,00.html

. mn.us/stats/62Q/75.html

sos.state.ms.us

Claims must be acknowledged within 10 days & paid or denied within 15 days of receipt of requested additional information. Interest penalty of 1% per month applies to claims not paid within 45 days. After 40 processing days provider is entitled to a per day penalty: 50% of claim (up to $20) if they notify the carrier. This penalty will accrue for 30 days only, unless the provider served notice again. Rules also stipulates that recontracted providers may file claims up to one year from date of service; contracted providers for 6 months unless contract states otherwise. Refunds can't be requested after 12 months.

Missouri State Medical Association (573) 636-5151

. us/bills01/bilsum01/truly01/ shb328t.htm

4

State

Montana

Prompt Pay Statutes and Regulations

Status/Terms of Law

State Contact

Clean claims must be paid within 30 days. Interest accrues at 18% per annum. Montana annotated code 3318-232.

Montana Dept. of Insurance (406) 444-5239

Website Address (If Available)

Nebraska Nevada New Hampshire New Jersey

Claims must be paid or denied Nebraska Dept. of

with in 15 days of affirmation Insurance

of liability.

(402) 471-0888

OS/Rules/ins/ins61.htm

Claims must be paid in 30 days. Penalty interest accrues at rate set forth in Nevada Revised Statute 99.040. Effective Jan 1, 2001 clean paper claims must be paid in 45 days, electronic in 15. 1.5% monthly interest penalty. Clean, electronic claims must be paid within 30 days, paper claims within 40 days.

Nevada Insurance Division (702) 486-4009

New Hampshire Dept. of Insurance (603) 271-2261

New Jersey Dept. of Health (609) 292-5316 ex. 50528

html/XXXVII/415/415-6-h.htm

New Mexico New York North Carolina

Clean claims must be paid within 30 days if electronic, 45 days if paper. Interest accrues at 1?% per month.

Claims must be paid with 45 days. Interest accrues at greater of 12% per year or corporate tax rate determined by Commissioner. Fines up to $500/day possible.

New Mexico Dept. of Insurance (505) 827-4545

New York Medical Society (518) 465-8085

efault.asp

(click New Mexico statutes, click N.M. statutes annotated, click through to 59A-2-9.2)

Claims must be paid or denied within 30 days. Annual interest penalty of 18%.

North Carolina Dept. of Insurance. ? Managed Care Dept. (919) 733-2032

/Statutes/EnactedLegislatio n/Statutes/HTML/BySection /Chapter_58/GS_58-3225.html

5

State

North Dakota

Prompt Pay Statutes and Regulations

Status/Terms of Law

State Contact

Claims must be paid within 15 1-800-247-0560

days.

North Dakota Dept.

of Insurance

Website Address

(If Available)

state.nd.us/lr/index.ht ml

(Click 26.1, look for 26.1-36-37.1)

Ohio

Oklahoma Oregon Pennsylvania Rhode Island

Payor must notify provider within 15 days of receipt if claim is materially deficient; payor must process claims in 30 days if no supporting documentation is needed. If payor requests additional information (must be done within 30 days of receipt of claim). Claim must be processed in 45 days from receipt of requested information.

Ohio Dept. of Insurance (614) 644-2658

Clean claims must be paid within 45 days. Penalty of 10% of claim as interest for late claims.

Oklahoma Dept. of Health (405) 222-4864 (405) 521-6624

Click file a complaint Provider complaint Prompt Pay

lsb.state.ok.us Click OK Statutes & Constitution, Statute database 63-2514

Effective Jan. 1, 2002 clean claims must be paid in 30 days. 12% interest penalty applies.

Clean claims must be paid in 45 days. Provider must be licensed in Pennsylvania

Oregon Dept. of Insurance (503) 947-7205

Pennsylvania Insurance Dept. (717) 783-0442

Click rules 743.866

ure/data/031/chapter154/s1 54.18.html

Written claims to be paid in 40 Rhode Island Dept.

calendar days, electronic in 30 of Insurance

days.

(401) 222-2223

atutes/title27/27-18/27-1861.htm

6

State

South Carolina

Prompt Pay Statutes and Regulations

Status/Terms of Law

State Contact

Website Address (If Available)

Group health insurers must pay claims in 60 days.

South Carolina Dept. of Insurance (803) 737-6165

lpitr.state.sc.us

(Click on research, code of Laws, By title/chapter, Title 38, Chapter 71, scroll down to section 735)

South Dakota Tennessee

Electronic claims must be paid South Dakota Dept. in 20 days, paper claims in 40. of Insurance

(605) 773-3563

ons/2001/bills/SB231SHE.h tm

Clean, commercial claims sent electronically must be paid within 21 days, paper claims in 30 days. Interest accrues at 1% per month.

Tennessee Dept. of Insurance ? Legal Dept. (615) 741-2199

. Laws & Justice Laws & Rules TN Code & Constitution 57-7109

Texas Utah Vermont Virginia Washington

Effective 9/1/03 Paper claims to be paid in 45 days and electronic in 30. Interest accrues at 18%. Effective 9/1/01 claims must be paid or denied in 30 days. Penalty interest may be applied according to formula.

Texas Dept. of Insurance (512) 305-7277

Utah Dept. of Insurance (801) 538-3800 (801) 538 3820

Claims must be paid or denied Vermont Dept. of

in 45 days. Interest penalty is Insurance

12% per annum.

(802) 828-3301

Clean claims must be paid within 40 days.

Virginia Legislative Services (804) 786-3591

95% of the monthly volume of clean claims shall be paid in 30 days. 95% of the monthly volume of all claims shall be paid or denied within 60 days.

Washington Insurance Comm. (360) 725-7000

s/statutes/in/in0020A00.htm l#in038.20A.18B.

001/bills/sbillenr/SB0069.ht m

tes/fullsection.cfm?title=18&ch apter=221§ion=09418

st/LH807640.HTM chapter 38.2-3407.15

insurance.

(Click on rules/laws, click on 284 WAC Insurance Reg., click on 284-43, then 284-43-321)

7

State

West Virginia

Wisconsin Wyoming

Prompt Pay Statutes and Regulations

Status/Terms of Law

State Contact

Claims must be paid in 30 days if electronic, 40 days if paper. Interest and fines may apply. Interest penalty of 10% per annum. If clean claims are not paid within 30 days they are subject to a penalty interest rate of 12% per year. Claims must be paid within 45 days. Penalties and fines may accrue.

West Virginia Div. of Insurance (304) 558-3386

Wisconsin Dept. of Insurance (608) 261-8563

Wyoming Dept. of Insurance (307) 777-7401

Website Address (If Available)

3/WVC%2033%20%20%2045%20%20%20%20%202%20%20.htm

rsb/statutes.html

(Click 628, then 628.46)

statutes/titles/title26/chapte r15.htm

(Scroll down to 26-15-124)

8

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download