Summaries of Key Payer Reimbursement Time Frames and Penalties
The following information provides summaries of potential time frames that payers must follow for reimbursing services rendered by health care providers within the 50 states, US territories, ERISA, and Medicare Advantage. It also delineates potential penalties in place if payers miss these time frames within each jurisdiction.1 This is provided for informational purposes only, is subject to change, and should not be construed as legal advice.
Sort for your state:
Alabama
Days to Pay: 30
Penalty: 1.5% per month
Authority: Alabama Insurance Code Section 27-1-17
Alaska
Days to Pay: 30
Penalty: 15% per year
Authority: Alaska Statutes Section 21.36.495
Arizona
Days to Pay: 30
Penalty: Legal rate*
Authority: Arizona Revised Statutes Section 20-3102
Arkansas
Days to Pay: 30
Penalty: 12% per year
Authority: Arkansas Department of Insurance Rule 43 § 12
California
Days to Pay: 30 working days
Penalty: 15% per year
Authority: California Health and Safety Code Section 1371.35
Colorado
Days to Pay: 30
Penalty: 10%-20% per year
Authority: Colorado Revised Statute Section 10-16-106.5
Connecticut
Days to Pay: 20
Penalty: 15% per year
Authority: Connecticut Insurance Code Section 38a-816
Delaware
Penalty: N/A
Authority: Delaware Administrative Code Rule 1310, Section 6.0
District of Columbia
Days to Pay: 30
Penalty: 1.5%–2.5% per month
Authority: Code of District of Columbia Section 31-3132
Florida
Days to Pay: 20
Penalty: 12% per year
Authority: Florida Insurance Codes Section 627.6131
Georgia
Days to Pay: 15 working days
Penalty: 12% per year
Authority: Georgia Insurance Code Section 33-24-59.5
Guam
Days to Pay: 45
Penalty: 12% per year
Authority: Title 10 Guam Statutes Section 9902
Hawaii
Days to Pay: 15
Penalty: 15% per year
Authority: Hawaii Revised Statutes Section 431:13-108
Idaho
Days to Pay: 30
Penalty: N/A
Authority: Idaho Statutes Section 41-5602
Illinois
Days to Pay: 30
Penalty: 9% per year
Authority: Illinois Insurance Code Section 5/368a
Indiana
Days to Pay: 30
Penalty: TBD
Authority: Indiana Insurance Code Section 27-8-5.7
Iowa
Days to Pay: 30
Penalty: 10% per year
Authority: Iowa Administrative Code Rule 191-15.32 (2)
Kansas
Days to Pay: 30
Penalty: 1% per month
Authority: Kansas Statutes Chapter 40, Section 2442
Kentucky
Days to Pay: 30
Penalty: 12%–21% per year
Authority: Kentucky Insurance Code Section 304.17A-702
Louisiana
Days to Pay: 25
Penalty: 1% per month
Authority: Louisiana Department of Insurance Regulation 74
Maine
Days to Pay: 30
Penalty: 1.5% per month
Authority: Maine Insurance Code Section 2436
Maryland
Days to Pay: 30
Penalty: 1.5%–2.5% per month
Authority: Maryland Insurance Code Section 15-1005
Massachusetts
Days to Pay: 45
Penalty: 1.5% per month
Authority: Massachusetts Insurance Code Chapter 176I Section 2
Michigan
Days to Pay: 45
Penalty: 12% per year
Authority: Michigan Insurance Code Section 500.2006
Minnesota
Days to Pay: 30
Penalty: 1.5% per month
Authority: Minnesota Insurance Code Section 62Q.75
Mississippi
Days to Pay: 25
Penalty: 3% per month
Authority: Mississippi Insurance Code Section 83-9-5
Missouri
Days to Pay: 30 processing days
Penalty: 1% per month†
Authority: Missouri Insurance Code Section 376.383
Montana
Days to Pay: 30
Penalty: 10% per year
Authority: Montana Code Annotated Section 33-18-232
Nebraska
Days to Pay: 30
Penalty: 12% per year
Authority: Nebraska Revised Statute Section 44-8004
Nevada
Days to Pay: 30
Penalty: Prime +6%
Authority: Nevada Revised Statutes Title 57 Section 689B.255
New Hampshire
Days to Pay: 15
Penalty: 1.5% per month
Authority: New Hampshire Insurance Code Section 420-J: 8-a
New Jersey
Days to Pay: 30
Penalty: 12% per year
Authority: New Jersey Administrative Code Rule 11:22-1.5 (a)
New Mexico
Days to Pay: 30
Penalty: 1.5% per month
Authority: New Mexico Statutes Section 59A-16-21.1
New York
Days to Pay: 30
Penalty: 12% per year
Authority: New York Insurance Code Section 3224a
North Carolina
Days to Pay: 30
Penalty: 18% per year
Authority: North Carolina Insurance Code Section 58-3-225
North Dakota
Days to Pay: 15 working days
Penalty: N/A
Authority: North Dakota Code Section 26.1-36-37.1
Ohio
Days to Pay: 30
Penalty: 18% per year
Authority: Ohio Revised Code Section 3901.381
Oklahoma
Days to Pay: 45
Penalty: 10% per year
Authority: Oklahoma Statutes Title 36 Section 1219
Oregon
Days to Pay: 30
Penalty: 12% per year
Authority: Oregon Revised Statutes Section 743B.450
Pennsylvania
Days to Pay: 45
Penalty: 10% per year
Authority: Pennsylvania Insurance Code Section 991.2166
Puerto Rico
Days to Pay: 30
Penalty: TBD
Authority: Laws of Puerto Rico Title 26, Section 3002
Rhode Island
Days to Pay: 30
Penalty: 12% per year
Authority: Rhode Island Insurance Code Section 27-18-61
South Carolina
Days to Pay: 20 working days
Penalty: 8.75%
Authority: South Carolina Insurance Code Section 38-59-230
South Dakota
Days to Pay: 30
Penalty: N/A
Authority: South Dakota Codified Laws Section 58-12-20
Tennessee
Days to Pay: 21
Penalty: 1% per month
Authority: Tennessee Insurance Code Section 56-7-109 (b)
Texas
Days to Pay: 30
Penalty: 18% per year‡
Authority: Texas Insurance Code Section 1301.103
Utah
Days to Pay: 30
Penalty: 0.033% per day
Authority: Utah Insurance Code Section 31A-26-301.6
Vermont
Days to Pay: 30
Penalty: 12% per year
Authority: Vermont Insurance Code Section 9418
Virginia
Days to Pay: 40
Penalty: Legal rate*
Authority: Code of Virginia Section 38.2-3407.15
Washington
Days to Pay: 30§
Penalty: 1% per month
Authority: Washington Administrative Code Rule 284-170-431
West Virginia
Days to Pay: 30
Penalty: 10% per year
Authority: West Virginia Insurance Code Section 33-45-2
Wisconsin
Days to Pay: 30
Penalty: 7.5% per year
Authority: Wisconsin Insurance Code Section 628.46
Wyoming
Days to Pay: 45
Penalty: 10% per year
Authority: Wyoming Statute Section 26-15-124
Alabama
Days to Pay: 30
Penalty: 1.5% per month
Authority: Alabama Insurance Code Section 27-1-17
Alaska
Days to Pay: 30
Penalty: 15% per year
Authority: Alaska Statutes Section 21.36.495
Arizona
Days to Pay: 30
Penalty: Legal rate*
Authority: Arizona Revised Statutes Section 20-3102
Arkansas
Days to Pay: 30
Penalty: 12% per year
Authority: Arkansas Department of Insurance Rule 43 § 12
California
Days to Pay: 30 working days
Penalty: 15% per year
Authority: California Health and Safety Code Section 1371.35
Colorado
Days to Pay: 30
Penalty: 10%–20% per year
Authority: Colorado Revised Statute Section 10-16-106.5
Connecticut
Days to Pay: 20
Penalty: 15% per year
Authority: Connecticut Insurance Code Section 38a-816
Delaware
Days to Pay: 30
Penalty: N/A
Authority: Delaware Administrative Code Rule 1310, Section 6.0
District of Columbia
Days to Pay: 30
Penalty: 1.5%–2.5% per month
Authority: Code of District of Columbia Section 31-3132
Florida
Days to Pay: 20
Penalty: 12% per year
Authority: Florida Insurance Codes Section 627.6131
Georgia
Days to Pay: 15 working days
Penalty: 12% per year
Authority: Georgia Insurance Code Section 33-24-59.5
Guam
Days to Pay: 45
Penalty: 12% per year
Authority: Title 10 Guam Statutes Section 9902
Hawaii
Days to Pay: 15
Penalty: 15% per year
Authority: Hawaii Revised Statutes Section 431:13-108
Idaho
Days to Pay: 30
Penalty: N/A
Authority: Idaho Statutes Section 41-5602
Illinois
Days to Pay: 30
Penalty: 9% per year
Authority: Illinois Insurance Code Section 5/368a
Indiana
Days to Pay: 30
Penalty: TBD
Authority: Indiana Insurance Code Section 27-8-5.7
Iowa
Days to Pay: 30
Penalty: 10% per year
Authority: Iowa Administrative Code Rule 191-15.32 (2)
Kansas
Days to Pay: 30
Penalty: 1% per month
Authority: Kansas Statutes Chapter 40, Section 2442
Kentucky
Days to Pay: 30
Penalty: 12%–21% per year
Authority: Kentucky Insurance Code Section 304.17A-702
Louisiana
Days to Pay: 25
Penalty: 1% per month
Authority: Louisiana Department of Insurance Regulation 74
Maine
Days to Pay: 30
Penalty: 1.5% per month
Authority: Maine Insurance Code Section 2436
Maryland
Days to Pay: 30
Penalty: 1.5%–2.5% per month
Authority: Maryland Insurance Code Section 15-1005
Massachusetts
Days to Pay: 45
Penalty: 1.5% per month
Authority: Massachusetts Insurance Code Chapter 176I Section 2
Michigan
Days to Pay: 45
Penalty: 12% per year
Authority: Michigan Insurance Code Section 500.2006
Minnesota
Days to Pay: 30
Penalty: 1.5% per month
Authority: Minnesota Insurance Code Section 62Q.75
Mississippi
Days to Pay: 25
Penalty: 3% per month
Authority: Mississippi Insurance Code Section 83-9-5
Missouri
Days to Pay: 30 processing days
Penalty: 1% per month†
Authority: Missouri Insurance Code Section 376.383
Montana
Days to Pay: 30
Penalty: 10% per year
Authority: Montana Code Annotated Section 33-18-232
Nebraska
Days to Pay: 30
Penalty: 12% per year
Authority: Nebraska Revised Statute Section 44-8004
Nevada
Days to Pay: 30
Penalty: Prime +6%
Authority: Nevada Revised Statutes Title 57 Section 689B.255
New Hampshire
Days to Pay: 15
Penalty: 1.5% per month
Authority: New Hampshire Insurance Code Section 420-J: 8-a
New Jersey
Days to Pay: 30
Penalty: 12% per year
Authority: New Jersey Administrative Code Rule 11:22-1.5 (a)
New Mexico
Days to Pay: 30
Penalty: 1.5% per month
Authority: New Mexico Statutes Section 59A-16-21.1
New York
Days to Pay: 30
Penalty: 12% per year
Authority: New York Insurance Code Section 3224a
North Carolina
Days to Pay: 30
Penalty: 18% per year
Authority: North Carolina Insurance Code Section 58-3-225
North Dakota
Days to Pay: 15 working days
Penalty: N/A
Authority: North Dakota Code Section 26.1-36-37.1
Ohio
Days to Pay: 30
Penalty: 18% per year
Authority: Ohio Revised Code Section 3901.381
Oklahoma
Days to Pay: 45
Penalty: 10% per year
Authority: Oklahoma Statutes Title 36 Section 1219
Oregon
Days to Pay: 30
Penalty: 12% per year
Authority: Oregon Revised Statutes Section 743B.450
Pennsylvania
Days to Pay: 45
Penalty: 10% per year
Authority: Pennsylvania Insurance Code Section 991.2166
Puerto Rico
Days to Pay: 30
Penalty: TBD
Authority: Laws of Puerto Rico Title 26, Section 3002
Rhode Island
Days to Pay: 30
Penalty: 12% per year
Authority: Rhode Island Insurance Code Section 27-18-61
South Carolina
Days to Pay: 20 working days
Penalty: 8.75%
Authority: South Carolina Insurance Code Section 38-59-230
South Dakota
Days to Pay: 30
Penalty: N/A
Authority: South Dakota Codified Laws Section 58-12-20
Tennessee
Days to Pay: 21
Penalty: 1% per month
Authority: Tennessee Insurance Code Section 56-7-109 (b)
Texas
Days to Pay: 30
Penalty: 18% per year‡
Authority: Texas Insurance Code Section 1301.103
Utah
Days to Pay: 30
Penalty: 0.033% per day
Authority: Utah Insurance Code Section 31A-26-301.6
Vermont
Days to Pay: 30
Penalty: 12% per year
Authority: Vermont Insurance Code Section 9418
Virginia
Days to Pay: 40
Penalty: Legal rate*
Authority: Code of Virginia Section 38.2-3407.15
Washington
Days to Pay: 30§
Penalty: 1% per month
Authority: Washington Administrative Code Rule 284-170-431
West Virginia
Days to Pay: 30
Penalty: 10% per year
Authority: West Virginia Insurance Code Section 33-45-2
Wisconsin
Days to Pay: 30
Penalty: 7.5% per year
Authority: Wisconsin Insurance Code Section 628.46
Wyoming
Days to Pay: 45
Penalty: 10% per year
Authority: Wyoming Statute Section 26-15-124
ERISA
Days to Pay: 30∥
Penalty: N/A
Authority: 29 CFR Section 2560.503-1
Medicare Part C
Days to Pay: 30¶
Penalty: TBD
Authority: 42 CFR § 422.520
Note: Days to pay assumes electronic submission. Days to pay time frames reflect calendar days unless otherwise noted.
* | The legal rates for incurring penalties can be no more than 10% per year in Arizona (unless a different rate is contracted for and agreed to in writing) and no more than 12% per year in Virginia.2,3 |
† | Missouri – Beginning processing day 45 a 1% per day penalty is added to the 1% monthly interest. |
‡ | Texas – 18% yearly interest is added to the additional penalty described in the NPC resource. |
§ | Washington time frame applies to 95% of all clean claims submitted. |
∥ | ERISA initial time frame is subject to 1-time extension of up to 15 days. |
¶ | Medicare Part C time frame applies to 95% of all clean claims submitted. |
ERISA = Employee Retirement Income Security Act.
References: 1. Data on file. Regeneron Pharmaceuticals, Inc. 44-1201. 2. Rate of interest for loan or indebtedness; interest on judgments; definitions. Arizona state legislature. Accessed May 21, 2024. https://www.azleg.gov/ars/44/01201.htm 3. Code of Virginia. Chapter 3. Interest and usury. Virginia’s Legislative Information System. Accessed May 21, 2024. https://law.lis.virginia.gov/vacodefull/title6.2/chapter3/#:~:text=Except
Note: Days to pay assumes electronic submission. Days to pay time frames reflect calendar days unless otherwise noted.
* | The legal rates for incurring penalties can be no more than 10% per year in Arizona (unless a different rate is contracted for and agreed to in writing) and no more than 12% per year in Virginia.2,3 |
† | Missouri – Beginning processing day 45 a 1% per day penalty is added to the 1% monthly interest. |
‡ | Texas – 18% yearly interest is added to the additional penalty described in the NPC resource. |
§ | Washington time frame applies to 95% of all clean claims submitted. |
∥ | ERISA initial time frame is subject to 1-time extension of up to 15 days. |
¶ | Medicare Part C time frame applies to 95% of all clean claims submitted. |
ERISA = Employee Retirement Income Security Act.
References: 1. Data on file. Regeneron Pharmaceuticals, Inc. 44-1201. 2. Rate of interest for loan or indebtedness; interest on judgments; definitions. Arizona state legislature. Accessed May 21, 2024. https://www.azleg.gov/ars/44/01201.htm 3. Code of Virginia. Chapter 3. Interest and usury. Virginia’s Legislative Information System. Accessed May 21, 2024. https://law.lis.virginia.gov/vacodefull/title6.2/
chapter3/#:~:text=Except
This material is provided for informational purposes only, is subject to change, and should not be construed as legal or medical advice. Use of this information to challenge or appeal a coverage or reimbursement delay and/or denial by a payer is the responsibility of the provider.