PROMPT PAYMENT OF CLAIMS

"Within twenty-four days of the receipt of a completed claim from a provider or a beneficiary for reimbursement for health care services rendered by the provider to a beneficiary, a third -party payer shall...make payment of any amount due on such claim." ORC § 3901.38 (B)

In negotiating a reimbursement contract, a third -party payer and a provider may agree to any time period by which a third -party payer shall make payment of any amount due on a completed claim. ORC § 3901.38 (B)

Any provider or beneficiary aggrieved with respect to any act of a third party payer that he believes to be a violation of the prompt payment provisions may file a written complaint with the Superintendent of Insurance. If a series of such complaints is received by the Superintendent with respect to a particular third party payer and if the Superintendent's investigation finds that such payer has engaged in a series of such violations which constitute a consistent pattern or practice of violations, the Superintendent shall order such payer to cease and desist from engaging in such violations and to pay a late payment penalty with respect to the claims the Superintendent finds were not timely paid. ORC § 3901.38 (B)

The late payment penalty shall be computed based upon the number of days that have elapsed between the date payment is due and the date payment is actually sent. The interest rate for determining the amount of the late payment penalty shall be the rate agreed to by the provider and the third -party payer or the rate specified by and determined in accordance with ORC § 1343.01 (A) (i.e., 8 per annum). ORC § 3901.38 (B)

Any state agency that purchases, leases, or otherwise acquires any equipment, materials, goods, supplies, or services from any person and fails to make payment by the required payment date shall pay an interest charge to the person. In applying this section to claims submitted to the Department of Human Services, the required payment date shall be the date on which payment is due under the terms of a written agreement between the Department and the provider. If a specific payment date is not established by a written agreement, the required payment date shall be thirty days after the Department receives a proper claim. If the Department determines that the claim is improperly executed or that additional evidence of the validity of the claim is required, the Department shall notify the claimant within fifteen days after receipt of the claim. If the Department makes such notification to the provider, the required payment date shall be thirty days after receipt of the corrected claim. ORC § 126.30 (A) , (C)

The interest charge on amounts due by a state agency shall be paid to the provider for the period beginning on the day after the required payment date and ending on the day that payment of the amount due is made. The amount of the interest charge that remains unpaid at the end of any thirty -day period after the required payment date shall be added to the principal amount of the debt and thereafter the interest shall accrue on the principal amount of the debt plus the added interest charge. The interest charge shall be at the rate per calendar month that equals one/twelfth of the rate per annum prescribed by section 5703.47 of the Revised Code (i.e., the federal short-term rate plus three percent) for the calendar year that includes the month for which the interest charge accrues. ORC § 126.30 (E)

PROMPT PAYMENT OF CLAIMS