23 CAR § 15-110 – Processing of clean claims

(a) The provisions of this section shall only apply to persons that are defined as health carriers under 23 CAR § 15-103(b)(8).
(b) A health carrier shall pay or deny a clean claim within:
1. (1) Thirty (30) days after receipt by the health carrier if the claim was submitted electronically; or
2. (2) Forty-five (45) days after receipt if the claim was submitted by other means.
(c) A health carrier shall notify the health claimant within thirty (30) days after receipt of the claim if the health carrier determines that the claim must be processed in accordance with 23 CAR § 15-111.
(d)
1. (1) A health carrier which fails to pay or deny a clean claim in accordance with subsection (b) of this section or give notice in accordance with subsection (c) of this section shall pay a penalty to the health claimant for the period beginning on the sixty-first day after receipt of the clean claim and ending on the clean claim payment date (the delinquent payment period), calculated as follows.
2. (2) The amount of the clean claim payment multiplied by twelve percent (12%) per annum multiplied by the number of days in the delinquent payment period, divided by three hundred sixty-five (365).
3. (3) Such penalty shall be paid without any action by the health claimant.