Prompt Pay Complaints refer to the requirement imposed by the New York State on all health insurance companies. They are obligated to pay undisputed electronic claims within 30 days and undisputed paper claims within 45 days of receiving the claim. Alternatively, they can request any additional information needed from the member or provider within 30 days of receiving the claim, or deny the claim within the same period. When additional information is provided, and the obligation to pay is clear, health insurance companies must pay the claim within 15 business days of determination but no later than 30 days for electronic claims or 45 days for paper claims from receiving the additional information.
Prompt Pay Complaints: New York State’s Requirements for Health Insurance Companies