Virginia Timely Filing Law

Overview

Virginia requires insurers to process clean claims within 40 days under VA Code §38.2-3407.15. Timely filing applies to all claims regardless of submission method. Insurers must acknowledge receipt within 5 business days and notify you of any deficiencies. Interest accrues at 12% annually on late claims.

Key Requirements

1. Submit claims with complete member identification, provider credentials, dates of service, and proper coding.
2. Verify insurer receipt within 5 business days.
3. Incomplete claims fall outside the 40-day requirement. Insurers must identify deficiencies within 40 days.
4. Upon resubmission with corrections, a new 40-day period begins.
5. Insurers must pay 12% annual interest on claims paid after 40 days, accruing from day 41.

Penalties and Enforcement

The Virginia State Corporation Commission enforces timely filing compliance. Insurers who miss the 40-day deadline face fines and license sanctions. Interest accrues annually at 12%. Consumers and providers can file complaints with VA SCC. Systematic violations result in escalating penalties.

Appeals and Exceptions

Incomplete claims are excluded from the 40-day timeline. Once the insurer identifies missing information, you have the right to resubmit. Clean claim status determines whether deadlines apply. Claims with coding errors or documentation gaps are subject to additional review.

Interaction with Federal Law

Virginia's 40-day standard extends federal timelines. The No Surprises Act establishes 30 days for emergency out-of-network claims. Virginia's broader 40-day requirement applies to all claims. NSA rules do not preempt Virginia's requirement.

Common Questions