Most states have enacted prompt pay laws that require fully-insured plans, and in some cases self-funded non-ERISA plans to pay or deny a clean claim within specified timeframes. While separately defined in each law, a clean claim is typically a claim that contains no defect or impropriety including any lack of substantiating documentation that prevents the payment from being complete and/or does not require additional information.
The prompt pay laws may also address any of the following, which can vary by State:
- Timeframes for requesting additional information;
- Timeframes for resolving claims after receiving the requested information;
- Interest rates and/or penalties for failure to pay a clean claim on time.
This content is being provided as an informational tool. It is believed to be accurate at the time of posting and is subject to change. It is recommended that plans consult with their own experts or counsel to review all applicable federal and state legal requirements that may apply to their group health plan. By providing this information, Meritain Health is not exercising discretionary authority or assuming a plan fiduciary role, nor is Meritain Health providing legal advice.