Connecticut Timely Filing

Overview

Connecticut General Statutes Section 38a-816(15) requires all health insurers to pay or deny clean claims within 45 days of receipt. Claims not paid within 45 days accrue interest at 15% per year, calculated from the day following the 45-day deadline through the payment date. The Connecticut Insurance Department (CID) enforces this law.

Key Requirements

1. 45-Day Payment Deadline: All health insurers must process and pay clean claims or issue denials within 45 days of receipt. The clock begins when the insurer receives a complete claim.
2. 15% Annual Interest: Claims unpaid after day 45 accrue interest at 15% per year, computed daily from the day following the deadline through the payment date.
3. Clean Claim Standard: A clean claim is a complete submission with all required information. Incomplete claims do not trigger the 45-day period; the clock restarts upon complete resubmission.
4. Insurer Notification: Insurers must notify providers of missing information within 30 days of receipt and specify the deficiencies.
5. Pattern Enforcement: Pattern violations of the prompt pay rule can trigger CID market conduct examinations and civil penalties.

Penalties and Enforcement

The Connecticut Insurance Department enforces timely payment requirements under CGS §38a-816. Insurers that fail to pay clean claims within 45 days and refuse to pay interest are subject to complaint investigations. Pattern violations result in market conduct examinations, citations, and fines. Interest owed is in addition to the original claim amount and is mandatory.

Appeals and Exceptions

Providers have appeal rights for any claim denial. The primary exception to the 45-day timeline is fraud investigation, during which payment may be delayed. Once the fraud investigation concludes, the insurer must pay or deny the claim within 45 days. Emergency and urgent care must meet the same 45-day deadline.

Interaction with Federal Law

Connecticut's prompt pay law applies to state-regulated health insurance plans. Self-funded ERISA plans are exempt from state insurance regulation and follow federal claims processing requirements. Medicare and Medicaid have their own separate timelines that operate independently of Connecticut state law.

Common Questions