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When is your payer legally late?
Pick the state and the date the clean claim was received. Every deadline here is the state’s own statute, cited, for all fifty states.
Enter the date the payer received the claim. Not the date of service, and not the date you submitted it — the clock runs from receipt.
What Texas actually says
30 days for an electronically submitted clean claim, and 45 days for a paper one, under Texas Insurance Code 843.338.
Before you quote this to a payer
- Your contract may be shorter than the statute, and it governs. The law is a floor. A contracted turnaround of 21 days beats a statutory 30.
- The clock runs from receipt of a CLEAN claim. A payer that says the claim was not clean is arguing the clock never started. Get their definition and the date they say they received it, in writing.
- Self-funded ERISA plans are generally outside state prompt-pay law. A large employer plan may not be bound by any of this. Ask whether the plan is fully insured or self-funded before escalating.
- Medicare and Medicaid run on their own rules, not the state statute above.
This is a working tool, not legal advice. Statutes change, and the citation beside each state is the authority — not this page. If a deadline matters to a specific claim, read the statute and your contract. All fifty states, side by side.
Why this is worth knowing
Most practices chase aged claims by ringing and asking politely. A caller who can say “this was received on the fourth, your state allows thirty days, you are eleven days past the statutory deadline and interest is accruing” gets a different conversation — because the payer’s representative knows it is true and knows you know it.
It is also the single fastest way to find out whether a payer’s stated timeline is the law or a preference. A great deal of what practices are told about payment timing is the second one.
What this covers, and what it does not
48 states set a deadline this tool can compute. 2 do not, and it says so rather than approximating: Missouri counts “processing days”, a defined term that is not calendar days, and Washington sets a monthly-volume standard rather than a per-claim deadline. A confident wrong date is worse than no date, particularly on the one page here somebody might quote to a payer.
Questions
When is an insurer legally late paying a claim?
It depends on the state and on how the claim was submitted. Most states allow 30 calendar days for a clean claim sent electronically and 40 to 45 days for one sent on paper. The fastest is Hawaii at 15 days electronic; the slowest common figure is 45 days. The clock runs from the payer’s receipt of a CLEAN claim, not from the date of service.
What is a clean claim?
A claim with no defect, no missing information and no circumstance requiring special treatment that prevents timely payment. The definition varies by state and by contract, and it is where most prompt-pay disputes actually live: a payer arguing a claim was not clean is arguing the clock never started.
Does prompt pay law apply to self-funded employer plans?
Generally no. Self-funded ERISA plans are regulated federally and are usually outside state prompt-pay statutes. Ask whether a plan is fully insured or self-funded before escalating on a state deadline.
Does it apply to Medicare and Medicaid?
No — those programmes run on their own payment rules rather than the state statute. Medicaid managed care plans may be subject to separate state requirements.
What happens when a payer misses the deadline?
Most states attach interest automatically, commonly between 9% and 18% a year, and several require it to be paid without the provider asking. The rate and the trigger are in the state statute cited on this page.
Next step
Somebody to work the claims that are already late
An AR caller who quotes your state's own deadline back to the payer, full time, in your system, from $1,700 a month.
Or write to ops@softhomeglobal.com