Overview
Tennessee Code Annotated Section 56-7-109 requires all health insurers operating in Tennessee to pay or deny claims within 30 days for paper submissions and 21 days for electronic submissions. Claims not paid within the statutory deadline accrue interest at 1% per month from the day after the deadline passes.
Key Requirements
- Payment Timeline: Paper claims must be paid or denied within 30 days of receipt; electronic claims within 21 days of receipt. The clock starts upon receipt of a clean claim or a notice that information is missing.
- Clean Claim Standard: Incomplete claims do not trigger the 30/21-day period. The insurer must notify the provider of missing information within a reasonable timeframe; the deadline restarts upon complete submission.
- HMO Coverage: Health Maintenance Organizations (HMOs) are subject to the same timely filing requirements under TCA §56-7-105 by reference.
- Interest Calculation: Interest accrues at 1% per month on any claim not paid by the deadline, calculated from the day after the deadline passes through the payment date.
- Pattern Violations: Multiple violations may trigger market conduct examinations by the Tennessee Department of Commerce and Insurance (TDCI).
Penalties and Enforcement
The Tennessee Department of Commerce and Insurance enforces timely payment requirements. Insurers failing to pay claims within the statutory deadline and refusing to pay the mandated 1% monthly interest are subject to complaint investigations. Pattern violations can result in market conduct examinations, citation of unfair practices, and potential civil penalties. Interest owed is in addition to the original claim amount.
Appeals and Exceptions
Providers have the right to appeal a claim denial within Tennessee's appeal process, generally 30 days from receipt of the denial notice. Exceptions to the timely filing rule include claims under investigation for fraud, where the insurer may suspend the interest accrual period during the investigation. Emergency services must be processed according to the same timely filing deadlines.
Interaction with Federal Law
Federal Medicare regulations and HIPAA administrative simplification standards do not preempt Tennessee's timely filing requirements; Tennessee law applies to all state-regulated health insurance plans. Self-funded ERISA plans may be exempt from state timely filing law but are subject to federal claims processing requirements under ERISA Section 502.
Common Questions
What is Tennessee's interest rate on late insurance claims?
Tennessee law requires 1% per month interest on claims not paid within the statutory period, accruing from the day after the deadline. For paper claims, the deadline is 30 days; for electronic claims, 21 days.
Does TN law treat electronic claims differently from paper?
Yes. Electronic claims must be paid or denied within 21 days of receipt, while paper claims have a 30-day deadline under TCA §56-7-109.
Track Tennessee Claims Deadlines with Altair
Altair monitors state billing deadlines and tracks timely filing requirements by state. See how it works.
State laws change. This reference is current as of 2026-04-13. Consult state statutes or a healthcare attorney for definitive guidance.