An insurer shall, within 30 calendar days after receipt of a claim, pay or deny the claim, or request additional information. Failure to pay claims in the prescribed timeframe is subject to a penalty at a rate of 18% a year. While an insurer may be subject to sanctions by the insurance commissioner for violations of this section, an aggreived provider may nevertheless pursue any other action or remedy available under law.

Link to Existing Law: NC Gen. Stat. Chapter 58 §58-3-225

This law would be improved by explicitly including PBMs (or other agents/intermediaries) within the definition of health benefit plan to ensure that the law is applied to them. Notably, the law places a time limit on an insurer’s ability to recover of overpayments through offsetting of future payments, requiring that they be made within the two years after the date of the original claim payment.