Georgia Timely Filing Law

Overview

Georgia Code §33-24-59.5 establishes fast timely filing deadlines for health insurers. Electronic claims must be processed within 15 business days; paper claims within 30 business days of receipt. Unpaid claims after the deadline accrue interest at 18% per year, among the highest rates nationally. The Georgia Department of Insurance enforces these requirements.

Key Requirements

1. Electronically submitted clean claims must be processed within 15 business days of receipt.
2. Paper-submitted clean claims must be processed within 30 business days of receipt.
3. Interest accrues at 18% per annum on unpaid claims after the deadline.
4. Insurers must document claim receipt date to establish the deadline.
5. Incomplete claims must be rejected within the deadline with itemized missing information.

Penalties and Enforcement

Georgia Department of Insurance enforces timely filing violations with administrative penalties and regulatory action. Plans that systematically fail to meet deadlines face fines, license sanctions, and corrective action mandates. The 18% interest rate creates strong financial incentive for timely payment. Enforcement investigations often result in consumer restitution orders.

Appeals and Exceptions

Timely filing denials can be appealed to the insurer and escalated to Georgia Department of Insurance for regulatory review. No exceptions exist for incomplete claims submitted on time. Providers can challenge deadline calculations through regulatory complaint processes.

Interaction with Federal Law

Georgia timely filing requirements apply to plans regulated under Georgia Code. Federal ERISA standards for self-funded plans require 30-day decisions. Georgia's aggressive deadlines and 18% interest rate exceed federal minimums significantly.

Common Questions