Get to Know Missouri's Prompt Pay Law

June 22, 2016

In 2010, Missouri passed a prompt pay bill for commercial health insurance.  This law requires carriers to pay or deny claims within 45 days of receipt, or they face a penalty and interest. It also prohibits insurers from "suspending" claims, which could delay them indefinitely. 

 

The legislation was designed to speed up payments to healthcare providers. Delayed payments were especially problematic for rural providers.  In 2009, urban hospitals reported that 25% of their claims were more than 90 days past due; this number was 37% for rural hospitals.

 

You can find the full text of the law here. The basic provisions include:

 

  • Carriers must send acknowledgement of electronic claims within 48 hours of receipt.

  • Within 30 processing days of receiving a claim, carriers must notify the claimant whether the claim is clean or if more information is needed.

  • If the claim is clean, the carrier must pay or deny it.  Otherwise, the notice must include a request for more information.

  • The law lays out timelines for carriers to act on additional information that is sent. 

  • If the insurer does not pay a claim within 45 processing days, they owe the claimant interest and a penalty.  The interest is 1% per month, and the penalty is equal to 1% of the claim per day.

  • The claimant is not required to submit another claim to collect the interest and penalty.

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