State RegulationsNJ specificDifficulty 2/5
An electronic clean claim is submitted to a New Jersey carrier and remains unpaid when the 31st day arrives. Under the prompt-pay rules, what has occurred?
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Answer & full 3-part explanation (select an option above, or peek)
Why C is correct
N.J.S.A. 26:2J-8.1d and N.J.A.C. 11:22-1.6 require electronic clean claims to be paid within 30 calendar days. When the 31st day arrives with the claim unpaid, the carrier is past the deadline and late-payment interest begins accruing, as the prompt-pay framework and the Health Care Claims Authorization Processing and Payment Act (N.J.S.A. 17B:30-51 et seq.) contemplate. The New Jersey Department of Banking and Insurance enforces these consequences in market conduct.
Why the other options are wrong
- A) The electronic deadline is 30 days; waiting for a 60-day mark ignores the statutory window that has already run.
- B) An unpaid claim is not deemed withdrawn; it becomes a late claim with interest consequences.
- D) No hardship-proof deferral exists in the prompt-pay rules; the deadline runs regardless of the provider's circumstances.
Memory hook
Day 31 arrives, interest wakes up: 30 days is the whole window.