State RegulationsNC specificDifficulty 2/5
A Durham hospital submits a health claim to an insurer, which neither pays, denies, nor requests information about it. Under G.S. 58-3-225, within how long of receiving the claim must the insurer act, and what interest applies to late payment?
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Answer & full 3-part explanation (select an option above, or peek)
Why B is correct
Under G.S. 58-3-225(b), the insurer must pay, deny, or request additional information within 30 calendar days of receiving a claim (a claim is presumed received five business days after mailing or electronic transmission). Under G.S. 58-3-225(e), payments made late bear interest at 18 percent per annum, so inaction past the 30-day window is costly to the insurer.
Why the other options are wrong
- A) The statute's window is 30 calendar days, not 45, and the late-payment rate is 18 percent per annum, not 10 percent.
- C) The insurer must act within 30 calendar days, and 18 percent per annum interest does apply to late payments, so this option errs on both elements.
- D) The deadline is 30 calendar days, not 12 months, and the 18 percent rate is per annum rather than per month.
Memory hook
Health claims: 30 days to act, 18 percent a year if late.