A Durham hospital submits a health claim to an insurer. Under G.S. 58-3-225, within what period must the insurer pay, deny, or request information about the claim, and what is the consequence of paying late?

Why D is correct

G.S. 58-3-225(b) requires the insurer to pay, deny, or request further information within 30 calendar days after receiving a claim — a claim that is mailed or electronically transmitted is presumed received 5 business days after transmission. G.S. 58-3-225(e) makes late payments bear interest at 18% per annum. A request for information starts the statutory information loop rather than ending the insurer's obligation.

Why the other options are wrong

• A) The 90-day figure belongs to the information loop in G.S. 58-3-225(c), not to the 30-day pay/deny/request deadline in G.S. 58-3-225(b); and late payments do bear interest under G.S. 58-3-225(e).
• B) Sixty days is the provider claim-status reporting trigger in G.S. 58-3-225(g); the statutory response deadline is 30 calendar days.
• C) Failure to act within 30 calendar days does not automatically deny the claim; it accrues 18% per annum interest under G.S. 58-3-225(e).

Memory hook

30 days to act; sleep on it and owe 18% a year.