State RegulationsGA specificDifficulty 2/5
A Georgia medical provider submits an electronic claim to an insurer in a situation governed by the surprise billing provisions of Georgia's unfair claims article. If the insurer fails to pay, an unfair claims settlement practice has occurred when payment is not made within:
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
Under O.C.G.A. § 33-6-34(15)(B), failing to pay a provider within 15 working days for an electronic claim, or within 30 calendar days for a paper claim, is an unfair claims settlement practice in Georgia. Electronic claims get the shorter, working-day clock, and the Insurance Commissioner enforces the standard through the unfair claims article.
Why the other options are wrong
- A) The electronic-claim deadline is measured in working days, not calendar days, under O.C.G.A. § 33-6-34(15)(B).
- B) Thirty is the calendar-day figure and it applies to paper claims; electronic claims must be paid within 15 working days under O.C.G.A. § 33-6-34(15)(B).
- D) Ninety days has no support in the unfair claims article; O.C.G.A. § 33-6-34(15)(B) sets the electronic-claim deadline at 15 working days.
Memory hook
Electronic = 15 working days; paper = 30 calendar days — screens are fast, paper is slow.