Are you struggling to get your Work Comp or Auto claims paid timely? Learn what you can do!
Under Michigan’s Workers Compensation Rules:
Under Michigan law [MCL 500.3142(2) and (3)]: Entity Interest Rate Notes Worker's Comp 3% After 30 days (one time) Auto No Fault 12% simple interest After 30 days then 1% monthly Health Insurance Carrier 12% simple interest After 45 days Sources: Michigan Department of Insurance and Financial Services Michigan Workers Compensation Agency MCL 500.3142
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Michigan Law Requires Insurers to Pay Interest on Clean Claims Not Timely Paid
Clean Claims Act A clean claim must be paid within 45 days after it is received by the "health plan." The 45-day time period is tolled from the date the health plan notifies a health care provider that the claim contains defects. A health plan must notify the health care provider within 30 days after receipt of the claim by the health plan of all known reasons that prevent the claim from being a clean claim. If a health plan determines that 1 or more services listed on a claim are payable, the health plan shall pay for those services and shall not deny the entire claim because 1 or more other services listed on the claim are defective. A health care provider has 45 days, and any additional time the health plan permits, after receipt of a notice to correct all known defects. If a health care provider's response makes the claim a clean claim, the health plan shall pay the health care provider within the 45-day time period, excluding any time period tolled. If a health care provider's response does not make the claim a clean claim, the health plan shall notify the health care provider of an adverse claim determination and of the reasons for the adverse claim determination within the 45-day time period. A health care provider shall not resubmit the same claim to the health plan unless the 45-day time frame has passed. Definition of a Clean Claim A "clean claim" means a claim that does all of the following:
Penalties for Late Payment of a Clean Claim A clean claim that is not paid within 45 days shall bear simple interest at a rate of 12% per annum. The Director of DIFS may also impose a civil fine of not more than $1,000.00 for each violation not to exceed $10,000.00 in the aggregate for multiple violations. Filing a Clean Claim Complaint with the Department of Insurance and Financial Services A health care provider alleging that a clean claim has not been timely processed or paid may file a complaint with DIFS on form FIS 0284 and has a right to a determination of the matter by the Director or his or her designee. A health care provider or health plan may also seek court action. A health care provider can file a clean claim complaint. Individuals or policyholders cannot file a clean claim complaint. A health plan shall not terminate the affiliation status or the participation of a health care provider with a health maintenance organization provider panel or otherwise discriminate against a health care provider because the provider alleges that a health plan has violated Section 2006(7) to (14) of the Insurance Code. |
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