State RegulationsNC specificDifficulty 2/5
A North Carolina insurer receives a health claim and neither pays it, denies it, nor requests additional information. Under G.S. 58-3-225, within what period must the insurer act on the claim, and what interest applies to a 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),(e), within 30 calendar days after receiving a claim the insurer must pay it, deny it, or request needed information (a claim is presumed received five business days after mailing or electronic transmission); late payments bear interest at 18% per annum. The information-request option starts the statutory information loop rather than suspending the insurer's duty indefinitely.
Why the other options are wrong
- A) 60 days is the provider-claim status report trigger under G.S. 58-3-225(g), and 18% interest does apply to late payment.
- C) 90 days is the information-loop denial point under G.S. 58-3-225(c), far beyond the 30-day action deadline, and late payment still bears interest.
- D) 180 days is the minimum claim filing window insurers may require, not the insurer's response deadline.
Memory hook
Thirty days to pay, deny, or ask — or owe eighteen percent.