New Prompt Pay Law To Take Effect October 1

Christopher L. Nuland, Esq.
General Counsel

After several months of intense lobbying by the Florida Chapter and its allies, the Florida Legislature finally passed a Prompt Pay Bill during its recent Special Session. While not as comprehensive as the bill proposed during the Regular Session, the legislation is an improvement of the existing law. Among the highlights:

For Electronic Claims

  • HMOs and insurers must acknowledge the receipt of a claim within 24 hours.
  • HMOs and insurers must pay, contest, or deny a claim within 20 days.
  • A provider must provide requested additional information within 35 days of a request from an insurer or HMO.
  • HMOs and insurers must pay or deny all claims within 90 days. Any claim over 120 days must be paid.

For Paper Claims

  • HMOs and insurers must acknowledge the receipt of a claim within 15 days.
  • HMOs and insurers must pay, contest, or deny a claim within 40 days.
  • A provider must provide requested additional information within 35 days of a request from an insurer or HMO.
  • HMOs and insurers must pay or deny all claims within 120 days. Any claim over 140 days must be paid.

For Refund Requests

  • No refund requests may be made more than 30 months after payment.
  • Provider can contest an overpayment claim within 35 days, after which the managed care organization has 35 days to respond.

Other Provisions

  • Interest of 12% per year starts on the date a claim should have been paid.
  • HMO's and insurers may not retroactively deny a claim due to a patient's ineligibility more than 12 months after paying the claim.
  • A contracted primary care physician or admitting physician may not be precluded from providing covered inpatient services.
  • HMOs and insurers will be liable for the failure of their contracted networks to pay providers in accordance with the Prompt Pay Law.
  • The State Claims Dispute Program will include HMO and insurer disputes.

For further information, please contact the Chapter Office.