An insurer shall pay or deny a clean claim within 40 days of receipt of a paper claim and within 21 days of receipt of an electronic claim. Failure to remit timely payment will subject the outstanding claim to statutory interest.

Link to Existing Law: Title 38 Chapter 59 SECTION 38-59-230

This law would be improved by explicitly including PBMs (or other agents/intermediaries) within the definition of health insurance 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 18 months after the date of the original claim payment. Finally, the law explicitly prohibits any form of a private right of action, thus limiting the potential utility in the event of a violation by an insurer.