State RegulationsNC specificDifficulty 1/5
A North Carolina insurer receives a health insurance claim. Within how many calendar days must it pay the claim, deny it, or request additional information?
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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), within 30 calendar days after receiving a claim the insurer must pay it, deny it, or request the information needed to resolve it, and 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 the deadline carries real financial teeth.
Why the other options are wrong
- A) Fifteen days is the period within which an insurer must furnish claim forms after notice of claim, a different claims rule.
- C) No 45-day payment deadline exists for health claims; the statute's action window is 30 calendar days.
- D) Sixty days appears in the provider-claim status reporting rule, not in the pay-deny-or-request deadline.
Memory hook
Thirty days: pay, deny, or ask — or owe 18 percent.