Timeliness Standards

In accordance with state law, HMSA pays uncontested commercial claims not more than 15 calendar days after the date of receipt for electronic media claims (EMC) and 30 days for paper claims. If this requirement is not met, the claims in question are subject to interest provisions. QUEST Integration and Medicare Advantage plans accrue interest after 30 days for both EMC and paper claims.

If additional information (e.g., revenue, procedure or diagnosis code, medical report) is required to process the claim, or if additional time is required for review (e.g., eligibility verification, other-carrier information, authorization of services), HMSA notifies the provider within seven days after the date of receipt for EMC claims and 15 days for paper claims. In these instances, the additional time to obtain information and the time a provider takes to correct a claim are excluded from the interest calculation.

Revision History