Clean Claim Payment

A clean claim must be paid within 45 days after it is received by the "health plan." The 45-day time period is tolled from the date the health plan notifies a health care provider that the claim contains defects. A health plan must notify the health care provider within 30 days after receipt of the claim by the health plan of all known reasons that prevent the claim from being a clean claim.

If a health plan determines that 1 or more services listed on a claim are payable, the health plan shall pay for those services and shall not deny the entire claim because 1 or more other services listed on the claim are defective.

A health care provider has 45 days, and any additional time the health plan permits, after receipt of a notice to correct all known defects.

If a health care provider's response makes the claim a clean claim, the health plan shall pay the health care provider within the 45-day time period, excluding any time period tolled.

If a health care provider's response does not make the claim a clean claim, the health plan shall notify the health care provider of an adverse claim determination and of the reasons for the adverse claim determination within the 45-day time period.

A health care provider shall not resubmit the same claim to the health plan unless the 45-day time frame has passed.