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BC Advantage - 2022 Issue 7

Timely Claims Payment/Prompt Pay

I am constantly being asked what can be done when government and commercial payors are slow-walking claims for payment. The simple answer is to know your state and federal law.First, let's tackle the federal law which is 42 CFR § 447.45[1] aptly titled "Timely Claims Payment." The most important aspect of Part 447 – Payments for Services is the actual definition of a "clean claim," which is "one that can be processed without obtaining additional information from the provider (hospital, HMO, including an MCO, or entity that treats or provides coverage or services to individuals...

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