West Virginia W. Va. Code §33-45-2 requires insurers to pay or deny clean claims within 30 days of receipt. Late payments accrue interest at 10% per annum, and billers can file complaints with the West Virginia Offices of the Insurance Commissioner to recover unpaid claims and interest.
W. Va. Code §33-45-2 Prompt Pay Requirements
West Virginia'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 West Virginia
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, West Virginia law requires interest at 10% 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 West Virginia
- 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 10% per annum from day 31 through the payment date.
- File a WVOIC complaint with claim records, payer correspondence, and the interest calculation.
Altair tracks West Virginia prompt pay deadlines and flags claims approaching the 30-day window.
Frequently Asked Questions
What is West Virginia's prompt pay deadline?
West Virginia requires insurers to pay or deny clean claims within 30 days of receipt under W. Va. Code §33-45-2. Late payments accrue interest at 10% per annum until paid.
What interest rate applies to late claims in West Virginia?
West Virginia law sets the late payment interest rate at 10% per annum. The clock starts on day 31 after the insurer receives a clean claim.
How do I file a prompt pay complaint in West Virginia?
Document the claim submission date, track the deadline, and file a complaint with the West Virginia Offices of the Insurance Commissioner if the insurer has not paid or denied within 30 days. Include proof of submission, the EOB, and interest calculations.
Related West Virginia Insurance Topics
- West Virginia Balance Billing Protections
- West Virginia Surprise Billing Protections
- West Virginia Prior Authorization Rules
- All State Billing Laws