ID H0829

Insurers must pay or deny electronic claims within 30 days and paper claims within 45 days of receipt, with 21-day deadlines for processing claims after receiving requested additional documentation.

Interest accrues on late payments at 10% annually for the first 180 days and 15% annually thereafter, with interest beginning from the date a complaint is filed with the Department of Insurance.

Administrative fines increase to $5,000 for first violations and $10,000 for subsequent violations within 36 months, and the director gains authority to suspend or revoke insurer licenses for repeated violations.

Practitioners and facilities may file civil lawsuits against insurers for violations, recovering actual damages, accrued interest, and attorney's fees; insurers are prohibited from retaliating against providers who exercise these rights.

Both insurers and healthcare providers must disclose when AI or automated decision tools are used in claims processing or documentation, though such disclosure alone cannot be used to deny claims or presume fraud.