No later than 30 days following receipt of a claim, a health plan, contracting entity, or payer shall do one of the following: (1) Pay or reimburse the claim. (2) Notify the claimant in writing that the claim is contested or denied. The notice shall include specific reasons supporting the contest or denial and a description of any additional information required for the health plan, contracting entity, or payer to determine liability for the claim. If a claim is contested because the health plan, contracting entity, or payer was not provided with sufficient information to determine payer liability and for which written notice has been provided as required above, then the health plan, contracting entity, or payer shall have 30 days after receipt of the additional information to complete consideration of the claim. Interest shall accrue on a claim at the rate of 12 percent per annum for overpaid claims.

Link to Existing Law: 18 V.S.A. §9418

The state regulates PBMs closely and this law would apply to PBMs under the health plan administrator. While there is no express clean claim language, plans must pay claims within 30 days of receipt.