State RegulationsGA specificDifficulty 2/5
A Georgia health care provider submits an electronic claim for covered services to an insurer. Under O.C.G.A. § 33-6-34(15)(B), the insurer's failure to pay the provider within what period makes the delay an unfair claims settlement practice?
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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 electronic claims — or within 30 calendar days for paper claims — is an enumerated unfair claims settlement practice. Electronic claims clear faster, so the statute gives them the shorter working-day window, and the Insurance Commissioner enforces both deadlines as part of the claims-practices article.
Why the other options are wrong
- A) 30 calendar days is the correct deadline for paper claims, not for electronic claims under § 33-6-34(15)(B).
- B) 15 calendar days is the claim-forms delivery window under § 33-6-34(11); the electronic-claim payment rule counts working days.
- D) 20 working days is not a period in the provider-payment rule; electronic claims must be paid within 15 working days.
Memory hook
Electronic = 15 working days; paper = 30 calendar days.