Maryland’s Prompt Pay law is stated in § 15-1005 of the Insurance Article. It applies to health policies issued in Maryland by insurers, nonprofit health services plans, health maintenance organizations, and managed care organizations (carriers). It does not apply to Medicare, including Medicare Advantage plans, or the Federal Employee Health Benefit Program. To the extent that the prompt payment law is consistent with ERISA, it may apply to self-funded benefit plans offered by employers, where the insurer, nonprofit health service plan, or health maintenance organization provides only administrative services. Property and casualty claims, including PIP and Worker’s Compensation claims, are not subject to the law.
This law requires payment within 30 days of receipt of a “clean” claim. Clean claims, and the information a carrier may request, are defined in COMAR 31.10.11. If a claim is not clean or is in dispute, notice stating the specific information required to process the claim must be sent within 30 days after receipt. Interest is required to be paid along with late claim payments. For a detailed understanding of the law, you should read the statute and regulations.
To file a complaint about a possible violation of the Prompt Pay law, you can use our online system.
If you have multiple complaints about the same carrier, please provide a representative sample of no more than 10 claims. Include the date of service, date of submission, how it was submitted (electronic or paper), and a copy of the claim form and member identification card, if available. If additional information was requested by the carrier, include the claim number, and the date of re-submission.
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