State RegulationsNC specificDifficulty 1/5
A Durham hospital submits a health claim to a North Carolina insurer. Within how many calendar days of receiving the claim must the insurer pay, deny, or request information, and what interest applies to late payment?
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under G.S. 58-3-225(b) and (e), the insurer must pay, deny, or request information within 30 calendar days after receiving a claim, and a claim is presumed received 5 business days after mailing or electronic transmission. Late payments bear interest at 18% per annum, which accrues automatically rather than on request.
Why the other options are wrong
- A) 60 days is the provider claim-status interval under G.S. 58-3-225(g), not the pay/deny deadline, and the interest rate is fixed by statute.
- B) 90 days belongs to the additional-information loop; the pay/deny deadline is 30 days and interest does apply to late payment.
- C) The 18% per annum interest obligation under G.S. 58-3-225(e) is automatic; no written complaint is needed to trigger it.
Memory hook
30 days to act, 18% if you are late.