For claims with a date of service on or after July 1, 2023, the Managed Care timely filing will be changing to 365 calendar days of covered service, or discharge, or a time period set by the health plan that is no less than 365 calendar days.

Managed Care claims with a date of service prior to July 1, 2023 still have a 180 day filing deadline.

Prompt Payment

Within 18 calendar days of receiving the medical claim, health plans are required to notify the provider whether the claim is clean, or pend the claim and request all additional information needed to timely process the claim.

Once the claim is clean upon submission, or becomes clean with the submission of additional information, health plans are required to pay or deny the claim within 30 days. If the provider does not submit the additional information requested within 90 days, the health plan can deny the claim.

Review the NCDHHS bulletin Fact Sheet Prompt Payment: Understanding prompt payment requirements for Standard and Tailored Plans for all the details!