Be well-versed with your state's prompt pay laws
Be well-versed with your state's prompt pay laws
You have submitted a claim that you know is clean but haven't received the payments even after three months. What do you do in such a situation? Can you wriggle out of this situation?
Yes, thanks to the prompt pay laws that each state must toe while paying your medical claims.
Prompt pay laws: Each state needs private insurers to pay all clean claims within a certain time frame. If the insurer doesn't pay the claim on time, then the payer is subject to paying interest on the charges owed to the practice. Even though each state publishes its own individual law, most range from 15 to 45 working days, with 30 days about the average.
How to find them: If you're a little adventurous, you could search for your state law on the Internet, although you should be aware that reading state laws and their multiple exceptions, references to other sections of state law, and 'legal-ese' can make this a very bothersome exercise.
Better bet: Take advantage of your local or state medical society and the experts they employ to see if your state has a prompt-pay law, and to which insurance companies it applies. The medical societies are on your side and will give you the right information.
Word of caution: State prompt laws do not apply to federal insurers as the federal government dictates that clean claims must be paid in 30 days for Medicare Part B. If a state wants a prompt pay rule that's longer or shorter, they certainly can do with reference to other payer service, however Medicare rules are Federal and span across the country.
As Medicare is a federal program, the 30-day threshold applies to all Medicare claims. However if the state of New York wants a 45-day prompt pay rule with reference to private insurance, which they have jurisdiction over, they can do that separately.
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