Overview
New York requires insurers to process clean claims within strict deadlines under NY Insurance Law §3224-a. Electronic claims must be received and processed within 30 days; paper claims within 45 days. Failure to meet these deadlines results in automatic claim denial and interest accrual at 12% per year.
Key Requirements
| Requirement | Deadline |
|---|---|
| Electronic claim processing | 30 days from receipt |
| Paper claim processing | 45 days from receipt |
| Interest on late payment | 12% annual rate from date claim is due |
| Clean claim definition | Complete, accurate claim per plan requirements |
- Clean claims filed electronically must be decided and paid within 30 days of receipt.
- Clean claims filed on paper must be decided and paid within 45 days of receipt.
- Interest accrues at 12% per annum on unpaid claims after the deadline passes.
- Insurers cannot deny a claim solely for missing timely filing deadlines if the claim is otherwise payable.
- Documentation of claim receipt is required to establish the timely filing deadline date.
Penalties and Enforcement
The New York Department of Financial Services (DFS) enforces timely filing requirements. Violations result in fines up to $1,000 per claim. Insurers that systematically fail to meet timely filing deadlines face regulatory sanctions, license restrictions, or license revocation. Interest penalties compound the financial impact of late claims, incentivizing prompt payment.
Appeals and Exceptions
Claims denied solely due to timely filing failure can be appealed directly to the insurer and escalated to NY DFS. There are no statutory exceptions for incomplete or non-clean claims—these must be rejected before the deadline or the insurer waives its right to deny. Providers can file complaints with DFS for regulatory review if they believe an insurer violated timely filing requirements.
Interaction with Federal Law
New York timely filing law applies to health plans subject to NY Insurance Law, including HMOs and PPOs. It works in parallel with federal requirements under ERISA for self-funded plans, though federal standards are generally less protective. Federal timely filing rules require payment decisions within 30 days for most claims, but NY adds enforcement teeth through DFS oversight.
Common Questions
What happens if a claim is filed after the NY deadline?
The claim is denied. NY Insurance Law §3224-a allows insurers to deny claims filed after 30 days electronic or 45 days paper without exception. Providers must appeal or refile if they believe the timing was outside their control.
Does NY require interest on late-paid claims?
Yes. Insurers must pay 12% annual interest on claims not paid within 30 days of receipt of a clean claim. Interest accrues from the due date forward until payment is made.
Track NY Deadlines Automatically
Altair tracks timely filing deadlines by state and payer. See how it works.
State laws change. This reference is current as of 2026-04-06. Consult NY Insurance Law §3224-a or a healthcare attorney for definitive guidance.