How Will the Department of Insurance Enforce the Prompt Pay Law?
For payors other than IPAs and PHOs, the Department of Insurance will enforce the Prompt Pay Law in the same way all insurance laws are enforced, including through the complaint process and market conduct exams. For IPAs and PHOs, the Prompt Pay Law grants specific authority to our Department for enforcement of this law. The Prompt Pay Law contains remedies (payment of interest) for claims that are not paid within the required time-fames. However, if a claim remains unpaid after the required date and the provider (or the patient) has not been notified by the payor of failure to provide sufficient documentation for a due proof of loss, we encourage the provider to contact the payor in writing to remedy the problem. If the claim remains unpaid after written remediation has been attempted directly, the provider may file a complaint using the Health Care Provider Complaint Form with the Department of Insurance. Verification of claim submittal and documentation of all efforts to obtain paym
