A health care entity or health plan operating in the state shall pay all complete claims for covered health care services submitted to the health care entity or health plan by a health care provider or by a policyholder within 40 calendar days following the date of receipt of a complete written claim or within 30 calendar days following the date of receipt of a complete electronic claim. _Each health plan shall establish a written standard defining what constitutes a complete claim and shall distribute this standard to all participating providers. In the event that a health care entity or health plan denies or pends a claim, and provides notification in writing the health care provider of any and all reasons for denying or pending the claim and what, if any, additional information is required to process the claim, there can be no limit the time period in which additional information may be submitted to complete a claim._A health care entity or health plan which fails to reimburse the health care provider or policyholder after receipt by the health care entity or health plan of a complete claim within the required timeframes shall pay to the health care provider or the policyholder who submitted the claim, in addition to any reimbursement for health care services provided, interest which shall accrue at the rate of 12% per annum.

Link to Existing Law: RI Gen. Laws Title 27 Chapter 27-18 §27-18-61

This law would be improved by explicitly including PBMs (or other agents/intermediaries) within the definition of health care entity to ensure that the law is applied to them. In addition, this law gives plans discretion in setting forth what consitutesa clean claim, and could be subject to abuse.