Wisconsin insurance law requires health insurers to pay clean claims promptly. Understanding these requirements protects medical practices from cash flow delays and helps you recover interest on unpaid claims.
Wisconsin Timely Filing Statute and Payment Deadline
Wisconsin Stat §628.46 mandates that health insurers must pay clean claims within 30 days of written notice of covered loss. This 30-day clock begins when the insurer receives written notification that a covered loss has occurred—typically the date the claim arrives at the insurer's processing facility.
Interest Rate on Late Wisconsin Claims
When an insurer fails to pay within 30 days, Wisconsin law imposes an automatic interest rate of 7.5% per year on the unpaid claim amount. This interest accrues from day 31 onwards and does not require separate notice or demand to the insurer.
The "Reasonable Proof" Exception
Wisconsin Stat §628.46 includes a "reasonable proof" exception. If the insurer has reasonable proof that it is not responsible for the claim, the 30-day payment period does not apply—the claim is not deemed overdue. This exception narrows the circumstances under which an insurer can delay payment without incurring interest.
Incomplete Claims and Claim Submission
If you submit an incomplete claim, the insurer must request the missing information within 15 business days. Once you resubmit with complete information, a new 30-day payment deadline starts. The insurer cannot restart the clock repeatedly by requesting marginal additional information.
Wisconsin Insurance Department Enforcement
The Wisconsin Office of the Commissioner of Insurance (OCI) enforces prompt pay requirements. You can file a complaint through oci.wi.gov if an insurer violates timely filing rules. The OCI investigates pattern violators and can impose penalties.
How to Collect 7.5% Annual Interest on Late Wisconsin Claims
- Document the date you sent written notice of the loss to the insurer. Keep proof of receipt.
- Calculate 7.5% annual interest from day 31 onwards using the unpaid claim amount.
- Send a written demand to the insurer citing Wisconsin Stat §628.46 and stating the interest owed.
- If the insurer does not respond within 15 business days, file a complaint with the Wisconsin OCI at oci.wi.gov.
Altair automates Wisconsin timely filing tracking and interest calculations so you never miss a deadline or underpayment.
Frequently Asked Questions
What is Wisconsin's annual interest rate on late claim payments?
Wisconsin Stat §628.46 imposes 7.5% annual interest on claims not paid within 30 days of written notice of covered loss. This is one of the lowest state rates and accrues automatically from day 31.
What is the "reasonable proof" exception in Wisconsin Stat §628.46?
If an insurer has reasonable proof that it is not responsible for the claim, the 30-day payment deadline does not apply and the claim is not deemed overdue. This exception applies only to claims the insurer can demonstrate are not its responsibility.
How long can an insurer take to request missing claim information?
The insurer must request missing information within 15 business days of receiving an incomplete claim. Once you submit the complete claim, a new 30-day payment period begins.
Related Wisconsin Insurance Topics
- Wisconsin Balance Billing Protections
- Wisconsin Surprise Billing Protections
- Wisconsin Prior Authorization Rules
- All State Billing Laws