How long insurance companies have to pay claims depends on the payer and the state. Medicare sets a 30-day ceiling for clean claims, and interest is owed on a payable clean claim that is still unpaid after that. Medicare also has a payment floor, so a contractor will not release payment before day 14 for electronic claims or day 29 for paper claims.
Commercial payers follow state prompt payment laws, and the deadlines vary. Many states fall between 30 and 45 days for a clean claim, some set shorter windows for electronic submissions, and some add statutory interest or penalties for late payment. Self-funded employer plans are generally exempt from state prompt payment laws and follow federal claims rules and their own plan documents.
The clock starts only when the payer receives a clean claim. A claim with missing information, a coding error, or an open request for records does not start it until the payer has what it needs. Submitting claims that pass the first time is the most direct way to get paid inside the window, and your clean claim rate shows how many of your claims qualify.
Payer contracts can set their own payment terms, usually in a timely payment clause, and those terms often match or shorten the legal minimum. Read the contract for the deadline, the interest rate on late payment, and the way the payer defines a clean claim. The guide to payer contract analysis shows where payment terms sit in a typical agreement.
When a payer misses its deadline, note the date it received the claim, cite the state statute or the contract clause, and request payment with any interest owed. Keep the clearinghouse confirmation as proof of receipt.