Rhode Island R.I. Gen. Laws §27-18-61 requires insurers to pay or deny clean claims within 30 days of receipt. Late payments accrue interest at 12% per annum, and billers can file complaints with the Rhode Island Department of Business Regulation to recover unpaid claims and interest.
R.I. Gen. Laws §27-18-61 Prompt Pay Requirements
Rhode Island's prompt pay statute applies to all health insurance claims submitted to state-regulated carriers. A clean claim is one that contains all information required for adjudication without need for additional documentation. Payers must pay or deny clean claims within 30 days of receipt; partial payments or requests for additional information restart the clock only for the portion of the claim still in dispute.
What Counts as a Clean Claim in Rhode Island
A clean claim includes complete patient demographics, a valid NPI for the rendering and billing providers, correct CPT/HCPCS codes with required modifiers, ICD-10 diagnosis codes that support medical necessity, date of service, place of service, and prior authorization numbers when applicable. Claims missing any of these elements are not clean and do not trigger the prompt pay deadline.
Interest Penalties on Late Payments
When a payer misses the 30-day deadline, Rhode Island law requires interest at 12% per annum on the unpaid balance. Interest accrues from day 31 until the payment posts. Billing teams should calculate interest on every late payment and include it on the follow-up demand so the payer pays both the claim and the statutory penalty.
Electronic vs. Paper Submission Timing
Electronic claims are considered received when the payer's clearinghouse issues a 277CA acknowledgment. Paper claims are considered received on the date the payer's mailroom stamps the envelope. Track both dates to start the 30-day clock accurately and to establish proof of receipt for prompt pay disputes.
How to File a Prompt Pay Complaint in Rhode Island
- Note whether the claim was electronic or paper and calculate the 30-day deadline from receipt.
- Document the clean claim submission date with clearinghouse records or mailroom stamps.
- Calculate interest at 12% per annum from day 31 through the payment date.
- File a RIDBR complaint with claim records, payer correspondence, and the interest calculation.
Altair tracks Rhode Island prompt pay deadlines and flags claims approaching the 30-day window.
Frequently Asked Questions
What is Rhode Island's prompt pay deadline?
Rhode Island requires insurers to pay or deny clean claims within 30 days of receipt under R.I. Gen. Laws §27-18-61. Late payments accrue interest at 12% per annum until paid.
What interest rate applies to late claims in Rhode Island?
Rhode Island law sets the late payment interest rate at 12% per annum. The clock starts on day 31 after the insurer receives a clean claim.
How do I file a prompt pay complaint in Rhode Island?
Document the claim submission date, track the deadline, and file a complaint with the Rhode Island Department of Business Regulation if the insurer has not paid or denied within 30 days. Include proof of submission, the EOB, and interest calculations.
Related Rhode Island Insurance Topics
- Rhode Island Balance Billing Protections
- Rhode Island Surprise Billing Protections
- Rhode Island Prior Authorization Rules
- All State Billing Laws