Florida Managed Care - Prompt Pay Law
May 9, 20111,271 views
This regulation is directly from the Florida State Department of Insurance
and is specific for manage care/indemnity plans
If utilized properly, you will ensure your collections without having to beg and plead
from the desk of:
Mark Studin DC, FASBE(C), DAAPM, DAAMLP
The carriers have 20 days to pay or deny your claim if filed electronically and 40 days if filed by paper. Anything beyond that will result in a default of the payment of your claim and mandate a 12% penalty to be paid, by regulation. A telephone call will fall on deft ears, therefore create a paper trail with a demand for payment.
The Law:
|
20 calendar days after receipt of a 40 days after receipt of paper claims |
12% per year interest |
§§ 641.3155, 627.613 (2000), |
Language for your complaint:
Dear Claims Examiner:
The services rendered were billed within the Florida Insurance guidelines. It has now been beyond (20 or 40) working days allowed by Florida Prompt Pay Law, Section §§ 641.3155, 627.613 (2000), SB 46-E (2002)
Since you have violated this regulation we can submit this entire claim for summary judgment or arbitration through our legal counsel.
We would like to resolve this issue without using legal counsel. If we do go to court, It will cost you both the amount of the claim and attorney fees with 12% interest annually as mandated by regulation Section §§ 641.3155, 627.613 (2000), SB 46-E (2002)
We request payment within 3 weeks of the date of this letter for the resubmitted bill(s) as prescribed by law. By doing so we will waive the interest due us as described in the regulations previously cited. If we do not receive payment, we will be forced to litigate this matter and also file a complaint with the Florida Department of Insurance.
Office of Insurance Regulation
The Larson Building
200 E. Gaines Street
Tallahassee, Florida 32399-0305
850-413-3140