Accounts Receivable Follow Up Form Today’s Date:

Doctor: Patient Name:

Account Balance: Patient: Insurance:

Date of Service:

Date Claim Filed: Date of Last Activity:

Primary Insurance: Phone: Fax:

Secondary Insurance: Phone: Fax:

I Spoke With.... His/Her Position:

Was Claim Received? � Yes � No

Did Payor Pay Claim? � Yes � No Check # __________

If Claim Unpaid, Codes and Descriptors of Unpaid Services: 1. ___________________________________________ 2. ___________________________________________ 3. ___________________________________________ 4. ___________________________________________

Why Was Claim Not Paid? (Denial Reason.)

Action Taken (Be specific.) When Can We Expect Payment? _______________

© The Sage Associates, 1997 reimb./apealtr

APPEAL

LETTERS

© The Sage Associates, 1997 reimb./apealtr

APPEAL LETTERS Brief, To The Point, Clear

1. Restate all identification numbers from EOB 2. Get to the point in the first sentence: “This is to appeal the amount allowed for (date of service.” 3. Make it easy to read and understand

• bullets or numbered paragraphs • boldface type to focus attention • layman’s terms • keep to one page if possible

4. Be Nice

• Thank them for their help • Keep a sense of humor • Accept the responsibility for confusing them

5. Only discuss their basis for the denial, underpayment or cutback. Stay away from other

issues like: • “We’re board certified” • “This is the fourth time this patient has had this procedure” • “You’ve been mistreating us since 1980”

6. Copy the patient 7. Follow Up

© The Sage Associates, 1997 reimb./apealtr

Enforce Contract Rates

ABC Medical Practice 123 Hometown Road

Your Town, CA 90000

Healthcare Insurance Company Claims Review Section P.O. Box 1111 Moneyplace, CA 90000 Re: Edna Jones SSN: 123-45-1234 Claim: 231ER 45678HCI Employer Name: Your Phone Company Dear Claims Supervisor: This is to appeal the amount allowed for surgery on 12/17/9x. Our current contract with you ( dated 4/1/9x) calls for $50 per RBRVS unit according to the HCFA schedule dated 12/1/95. 1. The claim was paid at $38.60 per unit 2. The services rendered total 25.7 units 3. The correct reimbursement is $1,285. 4. Additional due $382.66 Code Contracted You Balance Billed RVUs Amount Paid Due 11111 12.7 $635.00 $494.09 $140.91 22222 16.0 @50% $400.00 $311.20 $ 89.00 33333 10.0 @ 50% $250.00 $ 97.25 $152.75 Totals $1,285.00 $902.54 $382.66 Sincerely, Susie Sharp Office Manager

© The Sage Associates, 1997 reimb./apealtr

Non-timely Payment of Claim Attached is a copy of your claim for service for your insured. As of this date, we have not received payment for days since we submitted the claim to you. We have not received any notice that the claim was not complete or any indication that the service was not properly authorized. Therefore, you appear to be in violation of California Health & Safety Code Sec. 1371 (see language below). We expect full payment due for these services to be remitted to us at once, along with the applicable interest due under the statute. Continuing violation of this statute will be reported to the California Department of Insurance or Department of Corporations as applies to your plan. HSC Sec. 1371 A health care service plan...shall reimburse claims or any portion of a claim, whether in state or out of state, as soon as practical, but no later than 30 working days after receipt of the claim by the health care service plan, or, if the health care service plan is a health maintenance organization, 45 working days after the receipt of the claim....If an uncontested claim is not reimbursed within the respective 30 to 45 working days after receipt, interest shall accrue at the rate of 10 percent per annum beginning with the first calendar day after the 30 or 45 working day period.

© The Sage Associates, 1997 reimb./apealtr

Non-timely Payment of Claim After Further Information Sent: Attached is a copy of our claim for services for your insured. As of this date, we have not received payment for days since we submitted to you the additional information you requested about this claim. We have not received any notice that the claim was being further contested or questioned or any indication that the service was not appropriately authorized. Therefore you appear to be in violation of California Health & Safety Code Sec. 1371 (see language below). We expect full payment due for these services to be remitted to us at once, along with applicable interest due under the statute. Continuing violation of this statute will be reported to the California Department of Insurance or Department of Corporation as applies to your plan. HSC Sec 1371 A health care service plan...shall reimburse claims or any portion of any claim, whether in state or out of state, as soon as practical, but no later than 30 working days after receipt of the claim by the health maintenance organization, 45 working days after receipt of the claim....If an uncontested claim is not reimbursed by delivery to the claimant’s address of record within the respective 30 or 45 working days after receipt, interest shall accrue at the rate of 10 percent per annum beginning with the first calendar day after the 30 or 45 working day period....If a claim or portion thereof is contested on the basis that the plan has not received all information necessary to determine payer liability for the claim or portion thereof and notice has been provided pursuant to this section, then the plan shall have 30 working days, or if the health care service plan is a health maintenance organization, 45 working days after receipt of this additional information to complete reconsideration of the claim.

© The Sage Associates, 1997 reimb./apealtr

Denial of Service of Alleged Failure to Meet Medical Necessity

After Prior Authorization Received Attached is a copy of our claim for services for your insured and copy of prior authorization we received from you. Your denial of the claim appears both inappropriate and also appears to be a per se violation of California Health & Safety Code Sec. 1371.8 (see language below). We expect prompt reimbursement of this claim. If we fail to receive reimbursement within the next 10 working days, we will be forced to refer this issue to the California Department of Corporations or Department of Insurance, as applies to your plan. HSC Sec.1371.8 A health care service plan that authorizes a specific type of treatment by a provider shall not rescind or modify this authorization after the provider renders the health care service in good faith and pursuant to the authorization.

© The Sage Associates, 1997 reimb./apealtr

Denial of Service for Alleged Failure to Meet Medical

Necessity Attached is a copy of our claim for services for your insured, for which you have denied payment, alleging lack of medical necessity. We urge immediate reconsideration of this action. The denial of services appears to be a per se violation of Health & Safety Code Section 1370.2 (see language below). In order to determine if this violation requires us to report this incident to the California Department of Insurance or Department of Corporations, as applies to your health plan, please advise us of the name, qualifications, training, background and relevant expertise of the reviewer that denied the claim in question. If you consider the reviewer’s identity to be confidential, then provision of the other information about the reviewer is still required pursuant to HSC Sec. 1370.2 We expect reconsideration of this claim or provision of this required information to be provided within the time frames specified by HSC 1371. Thank you for your consideration. HSC1370.2 Upon an appeal to the plan of a contested claim, the plan shall refer the claim to the medical director or other appropriately licensed health care provider...If...he or she is not competent to evaluate the specific clinical issues of the appealed claim, prior to making a determination, he or she shall consult with an appropriately licensed health care provider who is competent to evaluate the specific clinical issues presented in the claim...(which) means that the reviewer has education, training, and relevant expertise that is pertinent for evaluating the specific clinical issues that serve as the basis of the contested claim. The requirements of this section shall apply to claims that are contested on the basis of a clinical issue, the necessity for treatment or the type of treatment proposed or utilized.

© The Sage Associates, 1997 reimb./apealtr

Denial of Service Based on Inappropriate or Undocumentable Practice Guidelines

Attached is a copy of our claim for services for your insured, for which you have denied payment alleging lack of medical necessity. We urge your immediate reconsideration of this action. A copy of all referable chart notes, supporting reports and other explanatory material is attached. In our view, your denial of this service is not consistent with professionally accepted standards for judging medical necessity. For example, be aware that the American College of Physicians has established as official policy the following definition of medical necessity:

‘A test, procedure or investigation is medically appropriate if documentation supports that the results of the test, procedure or investigation would alter or influence the diagnosis, course of treatment or prognosis of the patient’s illness, disease or disability.’

All of the tests and treatments which were performed in connection with this claim clearly meet the requirements of this policy statement. Furthermore:

‘Appropriateness cannot be fairly judged by third parties except against standards based on scientifically acceptable data or professional consensus, as described in published documents. Such data and standards should be publicly available, explicitly referenced by the reviewer and rationale provided for denying a procedure if the practitioner’s judgment is contradicted in post-payment review or in medical necessity determination prior to payment.’

Should any of the services performed referenced in the claim be declared by your reviewer to not be medically necessary, please be advised that I fully expect the reviewer to comply with these policies, with disclosure of the reviewer’s appropriate training and background in this clinical area, and with appropriate references which support the reviewer’s position in this clinical case.

Late Payment - Sample Letter Demanding Payment of Non-Emergency Service Claims with Interest

[Physician Letterhead]

Date:

Re: Patient Name:Insurance Carrier I Health Plan I IPAInsurance ID Number:Date of Service:Billed Amount:Payment Received:Balance Due:

Dear [plan Administrator; IPA or Other Contracting Entity or DHS]:

We have not yet received [or have only received partial] payment for services provided to [Patient] on[Date of Service] in the amount of [Claim Amount]. The claim was sent to [Name of PlanlIPA or othercontracting entity] on [Date Claim Sent].

Under California law, HMOs (and their contracting entities) are required to pay uncontested claimswithin 45 days, and other third-party payors (and their contracting entities) within thirty (30) days. If theclaim is contested or denied, the plan must provide such written notice within the 30 or 45-day period.(Contested claims must be paid within the same time periods, after further required information has beensent.) [Under California law, DHS must make payment for claims by a small business or nonprofitorganization within 30 days after a claim is received, unless reasonable cause for nonpayment exists.][Under Medicare I am also entitled to receive payment for all clean claims within thirty (30) days.]

Otherwise, interest accrues on the late payment of full or partial claims at 15% per year for HMOs andother Knox-Keene plans (see Health & Safety Code §1371); 10% per year for health insurers (seeInsurance Code §10123.13); approximately 3.25% per annum for Medicare (see 42 U.S.C.§1395u(c)(2)(B)) or 0.25% per calendar day for Medi-Cal (see Government Code §927.6). To date wehave not received notice that this claim is being contested.

We are writing this letter to demand payment of the above-referenced claim in the amount of [ClaimAmount] plus [15%] [10%] [3.25%] [0.25%] interest [per year] [per day].

[Moreover, because interest was owed commencing [date] , and was not paid automatically asrequired by Health & Safety Code §1371 and 28 C.C.R. §1300.71G), we further demand the statutorysurcharge of $10.00 per claim, for a total surcharge of $ . If we do not receive payment in thisamount by [Date], we will consider legal action. Thank you in advance for your anticipatedcooperation. ]

Sincerely,

[Name of Physician]

cc: [Department of Managed Health Care][Department ofI nsurance][Department of Health Services]California Medical Association

11

Sample Verification of Benefits Appeal Letter

Date

Attn: Director of ClaimsInsurance Policy CarrierInsurance Policy Address

Re: Patient: Patient NamePolicy: Insurance Policy NumberInsured: Responsible Party NameTreatment Dates: Admission Date - Discharge DateAmount: Total Charges

Dear Director of Claims,

The above referenced claim was denied despite the fact that verification of benefits and/or preauthorization ofcare was obtained from your company. Please be advised, our facility relies on information received from yourcompany regarding coverage. We extended treatment in good faith based on the expectation of payment asquoted by your company.

Many state courts have held that insurers can be liable for misrepresentations made during coverageverification and utilization review. Such rulings often rely on the legal theory of equitable estoppel wherein aparty who makes a misstatement of fact is estopped from denying another party the right of benefits when thatparty relied on incorrect information to his or her detriment.

Further, most states have an Unfair Claims Settlement Practices Act prohibiting licensed insurance companiesfrom knowingly misrepresenting material facts or relevant policy provisions in connection with a claim. It isour position that your duty as the insurer is to provide accurate information at the time of verification ofbenefits/utilization review.

Based on this information, we request immediate payment of the above referenced claim in accordancewith the benefits quoted at the time of the patient's admission. We request a response to this appealwithin 14 days of your receipt.

Sincerely,

Patient Accounts Manager

------------- ----------------------------------------------------------------------------

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Alabama Clean claims paid within 45 working days, applies to HMO’s only.

Timikel Robinson (334) 206-5366 Alabama Dept. of Public Health

www.ADPH.org

Alaska Clean claims must be paid within 30 working days.

Katie Campbell (907) 465-4607 Alaska Div. of Insurance

http://old-www.legis.state.ak.us/cgi-bin/folioisa.dll/stattx01/query=/doc/{t8722}

Arizona Clean claims must be paid within 30 days or interest payments are required (usually about 10%)

Deborah Claw (602) 912-8444 Arizona Dept. of Insurance

http://www.id.state.az.us/publications/timely_pay.pdf

Arkansas Clean, electronic claims must be paid or denied in 30 calendar days, paper in 45. 12% per annum interest after 60 days.

Rosalind Minor (501) 371-2766 Arkansas Dept. of Insurance

http://www.state.ar.us/insurance (Click on Insurance Laws, Rules, and Regs #43)

California Claims must be paid within 45 working days for an HMO, 30 days for other health service plans. Interest accrues at 15% per annum or $15 penalty, whichever is greater.

(800) 400-0815 California Dept. of Managed Health Care

http://www.hmohelp.ca.gov/library/statutes/knox-keene/_Toc32032014

Colorado Claims must be paid in 30 calendar days if submitted electronically, 45 if paper. 10% annual interest penalty.

Michael Gillis (303) 894-7499 Colorado Div. of Insurance

http://198.187.128.12/colorado/lpext.dll?f=templates&fn=fs-main.htm&2.0

Connecticut Claims must be paid within 45 days. Interest accrues at 15% per annum.

Email gerard.o’sullivan@po.state.ct.us (860) 297-3889 Connecticut Dept. of Ins

http://www.ct.gov/cid/cwp/view.asp?a=1267&q=254456

1

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Delaware Clean claims must be paid in 30 days.

Johnii Bothell (302) 739-4251x123 Delaware Dept. of Insurance

Dist. of Columbia Clean claims will be paid in 30 days. Interest payable at 1.5% days 31-60, 2% days 61-120, and 2.5% after 120 days. Applies to claims received on or after October 16, 2002

Evette Alexander (202) 442-7786 Health Policy Advisor Dist. Of Columbia Dept. of Ins

http:disr.dc.gov/news_room/2003/February/02_05_03.shtm#top

Florida Clean HMO claims (paper or electronic) must be paid in 35 days, non-HMO in 45 days. Claims where information was requested must be paid in 120. Interest penalty is 10% per year. Statute # 31555

Health Ins. Division Pam White (850)-413-3132 Florida Dept. of Insurance

http://www.flsenate.gov/statutes/index.cfm?App_mode=Display_Statute&Search_String=&URL=Ch0627/SEC613.HTM&Title=->2002->Ch0627->Section%20613

Georgia Claims must be paid within 15 working days. Interest accrues at 18% per annum.

Yvonne Jones (404) 656-2164 Georgia Office of Ins. Comm.

http://www.legis.state.ga.us/cgi-bin/gl_codes_detail.pl?code=33-24-59.5

Hawaii Clean, paper claims must be paid in 30 days, electronic claims within 15 days. Interest accrues at 15% per annum. Commissioner may impose fines.

Paula Arcena (808) 536-7702 Hawaii Medical Association

www.state.hi.us

Idaho Paper Claims Settled in 45 days & electronic Claims in 30 days – Chapter 56

Joan Skrosch (208) 334-4300 Idaho Dept. of Insurance

http://www.doi.idaho.gov

Illinois Clean claims must be paid in 30 days. Interest accrues at 9% per annum.

(217) 524-4051 Illinois Dept. of Insurance 1-877-527-9431 (toll free)

www.legis.state.il.us Go to Senate Bill 251-1255-71a

2

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Indiana Paper claims must be paid in 45 day. Electronic claims must be paid in 30 days.

(317) 232-2395 Cindy Tompkins Indiana Dept. of Insurance

http://www.in.gov/idoi/health/payments.html

Iowa Payment to be made in 30 days. Penalty is 10% per annum.

Robin Spencer (515) 281-5523 Iowa Div. of Insurance

http://www.legis.state.ia.us/IACODE/2001SUPPLEMENT/507B/4A.html

Kansas Claims will be paid in 30 days. Interest accrues at a rate of 1% per month.

Steve O’Neil (785) 296-7826 Kansas Dept. of Insurance

http://www.kslegislature.org/cgi-bin/statutes/index.cgi

Kentucky Claims must be paid or denied within 30 calendar days. Interest accrues at 12% per annum when 31-60 days late, 18% 61-90 when days late and 21% when 91+ days late.

Daryl Thompson (800) 595-6053 X 4303 Kentucky Dept. of Insurance

http://www.lrc.state.ky.us/KRS/304-17A/CHAPTER.HTM (Click .702 and .730)

Louisiana Claims submitted electronically must be paid within 25 days. If not paid within 25 days the health insurance issuer shall pay to the claimant an additional late payment adjustment equal to 1 percent of the unpaid balance due for each month.

Cheryl Gordon (225) 219-9524 Louisiana Dept. of Insurance

http://www.ldi.state.la.us/office_of_health/quality_management/qm_reg74.htm

Maine Clean claims must be paid within 30 days. Interest accrues at 1.5% per month.

Rick Diamond or JoAnne Rowlings (207) 624-8428 Maine Bureau of Insurance.

http://janus.state.me.us/legis/statutes/24-A/title24-Asec2436.html www.maineinsurancereg.org

Maryland Clean claims must be paid within 30 days. Interest accrues at monthly rates of 1.5% (31-60 days late), 2% (61-120), and 2.5% (121+) respectively.

Jama Allers (410) 539-0872 The Maryland State Medical Society

http://mlis.state.md.us/1999rs/billfile/hb0639.htm (Click on House Bill 639)

Massachusetts MCL 500.2006 MCL 200.111

Nancy Schwartz (617) 521-7347 Massachusetts Div. of Ins.

3

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Michigan A clean claim submitted to an insurance co. with all the correct information shall be paid within 45 days. Penalty is 12% interest. The bills also hold Medicaid and HMO’s to this 45 day schedule.

Carol Rall (877)-999-6442 Michigan Dept. of Insurance

http://www.michigan.gov/minewswire/0,1607,7-136-3452_3482-35876--M_2002_5,00.html

Minnesota Clean claims must be paid in 30 days. Interest accrues at 1.5% per month if not paid or denied.

Irene Goldman (651) 282-6327 Minnesota Dept. of Health

http://www.revisor.leg.state.mn.us/stats/62Q/75.html

Mississippi Clean claims must be paid within 25 days if electronic, 35 days if paper claim. Interest accrues at 1.5% per month. .

Kathy Vernon (601) 359-3569 Mississippi Dept. of Ins.

www.sos.state.ms.us

Missouri Claims must be acknowledged within 10 days & paid or denied within 15 days of receipt of requested additional information. Interst penalty of 1% per month applies to claims not paid within 45 days. After 40 processing days provider is entitled to a per day penalty: 50% of claim (up to $20) if they notify the carrier. This penalty will accrue for 30 days only, unless the provider served notice again. Rules also stipulates that re-contracted providers may file claims up to one year from date of service; contracted providers for 6 months unless contract states otherwise. Refunds can’t be requested after 12 months.

Thomas Holloway (573) 636-5151 Missouri State Medical Assoc.

http://www.house.state.mo.us/bills01/bilsum01/truly01/shb328t.htm

Montana Clean claims must be paid within 30 days. Interest accrues at 18% per annum. Montana annotated code 33-18-232.

Ron Herman (406) 444-5239 Montana Dept. of Insurance

4

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Nebraska Claims must be paid or denied with in 15 days of affirmation of liability.

Scott Zaeger (402) 471-0888 Nebraska Dept. of Insurance

http://www.nol.org/home/SOS/Rules/ins/ins61.htm

Nevada Claims must be paid in 30 days. Penalty interest accrues at rate set forth in Nevada Revised Statute 99.040.

Kent Royal (702) 486-4009 Nevada Insurance Division

New Hampshire Effective Jan 1, 2001 clean paper claims must be paid in 45 days, electronic in 15. 1.5% monthly interest penalty.

Pauline Lamy (603) 271-2261 New Hampshire Dept. of Ins.

http://gencourt.state.nh.us/rsa/html/XXXVII/415/415-6-h.htm

New Jersey Clean, electronic claims must be paid within 30 days, paper claims within 40 days.

Veronica Schmidt (609) 292-5316 ex. 50528 New Jersey Dept. of Health

New Mexico Clean claims must be paid within 30 days if electronic, 45 days if paper. Interest accrues at 1½% per month.

Fred Couty (505) 827-4545 New Mexico Dept. of Ins.

http://legis.state.nm.us/lis/default.asp (click New Mexico statutes, click N.M. statutes annotated, click through to 59A-2-9.2)

New York Claims must be paid with 45 days. Interest accrues at greater of 12% per year or corporate tax rate determined by Commissioner. Fines up to $500/day possible.

Moe Auster (518) 465-8085 New York Medical Society

North Carolina Claims must be paid or denied within 30 days. Annual interest penalty of 18%.

Terrry Lorry (919) 733-2032 No. Carolina Dept. of Ins. – Managed Care Dept.

http://www.ncga.state.nc.us/Statutes/EnactedLegislation/Statutes/HTML/BySection/Chapter_58/GS_58-3-225.html

North Dakota Claims must be paid within 15 days.

Cydra Sauter 1-800-247-0560 No. Dakota Dept. of Ins.

www.state.nd.us/lr/index.html (Click 26.1, look for 26.1-36-37.1)

5

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Ohio Payor must notify provider within 15 days of receipt if claim is materially deficient; payor must process claims in 30 days if no supporting documentation is needed. If payor requests additional information (must be done within 30 days of receipt of claim). Claim must be processed in 45 days from receipt of requested information.

Tate Chaney (614) 644-2658 Ohio Dept. of Insurance

www.ohioinsurance.gov Click file a complaint Provider complaint Prompt Pay

Oklahoma Clean claims must be paid within 45 days. Penalty of 10% of claim as interest for late claims.

Sam Simms (405) 222-4864 Lydia Shirley 405-521-6624 Oklahoma Dept. of Health

www.lsb.state.ok.us Click OK Statutes & Constitution, Statute database 63-2514

Oregon Effective Jan. 1, 2002 clean claims must be paid in 30 days. 12% interest penalty applies.

Carolyn Hancock (503) 947-7205 Oregon Dept. of Insurance

www.oregoninsurance.org Click rules 743.866

Pennsylvania Clean claims must be paid in 45 days. Provider must be licensed in Pennsylvania

Pete Salvatore (717) 783-0442 Pennsylvania Ins. Dept.

http://www.pacode.com/secure/data/031/chapter154/s154.18.html

Rhode Island Written claims to be paid in 40 calendar days, electronic in 30 days.

Rollin Bartlett (401) 222-2223 Rhode Island Dept. of Ins.

http://www.rilin.state.ri.us/statutes/title27/27-18/27-18-61.htm

South Carolina Group health insurers must pay claims in 60 days.

Ann Bishop (803) 737-6165 South Carolina Dept. of Ins.

www.lpitr.state.sc.us (Click on research, code of Laws, By title/chapter, Title 38, Chapter 71, scroll down to section 735)

South Dakota Electronic claims must be paid in 30 days, paper claims in 45.

Randy Moses (605) 773-3563 So. Dakota Dept. of Ins.

http://legis.state.sd.us/sessions/2001/bills/SB231SHE.htm

Tennessee Clean, commercial claims sent electronically must be paid within 21 days, paper claims in 30 days. Interest accrues at 1% per month.

Susan Wittig (615) 741-2199 Tennessee Dept. of Ins. – Legal Dept.

www.tennessee.gov. Laws & Justice Laws & Rules TN Code & Constitution 57-7-109

6

“Prompt Pay” Statutes and Regulations

State Status/Terms of Law State Contact Website Address (If Available)

Texas Effective 9/1/03 Paper claims to be paid in 45 days and electronic in 30. Interest accrues at 18%.

Pat Brewer (512) 305-7277 Texas Dept. of Insurance

http://www.capitol.state.tx.us/statutes/in/in0020A00.html#in038.20A.18B.

Utah Effective 9/1/01 claims must be paid or denied in 30 days. Penalty interest may be applied according to formula.

Liz Kneisley or (801) 538-3800 Cheryl Alexander (801) 538 3820 Utah Dept. of Insurance

http://www.le.state.ut.us/~2001/bills/sbillenr/SB0069.htm

Vermont Claims must be paid or denied in 45 days. Interest penalty is 12% per annum.

(802) 828-3301 Vermont Dept. of Insurance

http://www.leg.state.vt.us/statutes/fullsection.cfm?title=18&chapter=221&section=09418

Virginia Clean claims must be paid within 40 days.

Bill Cramme (804) 786-3591 Virginia Legislative Services

http://leg1.state.va.us/000/lst/LH807640.HTM chapter 38.2-3407.15

Washington 95% of the monthly volume of clean claims shall be paid in 30 days. 95% of the monthly volume of all claims shall be paid or denied within 60 days.

John Hetiguard (360) 725-7000 Washington Ins. Comm.

www.insurance.wa.gov (Click on rules/laws, click on 284 WAC Insurance Regs., click on 284-43, then 284-43-321)

West Virginia Claims must be paid in 30 days if electronic, 40 days if paper. Interest and fines may apply. Interest penalty of 10% per annum.

Denna Wildman (304) 558-3386 West Virginia Div. of Ins.

http://129.71.164.29/wvcode/33/WVC%2033%20%20-%2045%20%20-%20%20%202%20%20.htm

Wisconsin If clean claims are not paid within 30 days they are subject to a penalty interest rate of 12% per year.

Stephanie Cook (608) 261-8563 Wisconsin Dept. of Insurance

http://www.legis.state.wi.us/rsb/statutes.html (Click 628, then 628.46)

Wyoming Claims must be paid within 45 days. Penalties and fines may accrue.

Lloyd Wilder or Mark Pring (307) 777-7401 Wyoming Dept. of Insurance

http://legisweb.state.wy.us/statutes/titles/title26/chapter15.htm (Scroll down to 26-15-124)

7