State RegulationsNC specificDifficulty 2/5
A hospital in Greensboro submits a health claim to an insurer. Under the prompt-pay statute, within how many calendar days after receiving the claim must the insurer pay it, deny it, or request additional information, and what interest applies to late payments?
Select an option to reveal the answer and the full 3-part explanation — free, no signup.
Answer & full 3-part explanation (select an option above, or peek)
Why A is correct
Under G.S. 58-3-225(b),(e), within 30 calendar days after receiving a health claim the insurer must pay it, deny it, or request needed information (a mailed or electronically transmitted claim is presumed received 5 business days later), and payments made late bear interest at 18% per annum.
Why the other options are wrong
- B) 90 days is the information-loop figure under G.S. 58-3-225(c) for requested material, not the insurer's pay-deny-request deadline.
- C) 60 days is when a status report is owed on unpaid, undenied provider claims under G.S. 58-3-225(g), and G.S. 58-3-225(e) does require interest on late payments.
- D) 180 days is the claim filing window insurers may require under G.S. 58-3-225(f), not the insurer's response deadline.
Memory hook
Thirty days to pay, deny, or ask, then 18% starts ticking.