Ohio charges 18% annual interest on late claims, but its prompt-pay law applies only to electronically submitted claims unless the provider’s contract says otherwise. Medicaid managed care plans are excluded and follow Department of Medicaid standards instead.
To see what a late Ohio payer owes on a specific claim, use the prompt pay interest calculator.
Ohio prompt pay at a glance
| Statute | Ohio Rev. Code ยงยง 3901.38 to 3901.3814 |
|---|---|
| Electronic clean claim | Pay or deny within 30 days of receipt |
| Paper clean claim | Not covered unless the provider contract extends it |
| Late payment | 18% annual interest |
| Regulator for complaints | Ohio Department of Insurance (ODI) |
The statute
ORC 3901.381 sets the payment periods, 3901.389 sets interest, and 3901.3814 lists exemptions. HMOs, which Ohio calls health insuring corporations, are third-party payers under 3901.38(F)(2).
SB 162, effective October 7, 2026, amended ORC 3901.388 so a payment becomes final after one year instead of two, and payers must start any overpayment recovery within one year.
Clean-claim payment deadlines
A third-party payer must pay or deny a claim within 30 days of receipt (ORC 3901.381). If it needs supporting documentation and requests it within the first 30 days, it has 45 days. A materially deficient claim must be flagged to the provider within 15 days, stating what is needed.
These periods and the interest rule apply only to electronically submitted claims, unless the provider’s contract says otherwise (ORC 3901.382). Paper claims have no statutory deadline.
Interest and penalties on late payment
Late claims carry interest at “an annual percentage rate of eighteen per cent,” counted from the due date to the payment date (ORC 3901.389). The interest is paid directly to the provider with the claim payment.
Not verified: that there is no minimum amount and no compounding. Both points come from ODI’s prompt-pay FAQ rather than the statute.
Which payers the law covers
- Commercial fully insured plans: Covered as third-party payers under ORC 3901.38.
- HMOs: Covered. Health insuring corporations are listed third-party payers.
- Medicaid managed care plans: Excluded by ORC 3901.3814(D). Prompt pay comes from the Department of Medicaid provider agreement, which ODM describes as 90% of clean claims within 21 days, 99% within 60 days, and 100% within 90 days.
- Self-funded ERISA plans: Exempt to the extent ERISA preempts state law (ORC 3901.3814). ODI refers these to the U.S. Department of Labor.
Medicare Advantage, TRICARE, and auto and property-casualty coverage are also exempt under ORC 3901.3814.
How to file a prompt-pay complaint
Providers file through ODI’s Provider Help Center, online through the Provider Inquiries Application after signing in with OH|ID, or by hard copy to the Provider Complaint Unit, 50 W. Town St., Suite 300, Columbus, OH 43215. ODI routes the inquiry to the payer, which must report its resolution within 15 business days.
For a Medicaid managed care plan, first use the plan’s dispute process and contact the plan. If the plan does not respond within five business days, file on the ODM provider complaint form.
How prompt pay interacts with timely filing
Ohio sets no general statutory filing window for commercial claims; its one statutory rule, ORC 3901.384, requires a payer to accept a late claim first sent to the wrong payer if the provider resubmits within 45 days of that payer’s denial, and Medicaid fee-for-service claims are timely within 365 days of service (OAC 5160-1-19(D)). Because the 30-day clock covers only electronic claims, a paper claim filed inside the contract window can sit with no statutory payment deadline at all. Our 2026 timely filing guide compares filing limits by payer.
What we could not verify
- The Medicaid managed care 21, 60, and 90 day figures, which come from ODM web pages and a July 2024 FAQ rather than a statute or rule. An older ODM page still shows 30 and 90 days.
- A general timely filing window for Medicaid managed care claims.
- Whether the law covers the State of Ohio employee plan or other non-ERISA self-insured government plans.
- A downloadable paper provider complaint form. ODI says hard copies are accepted at the address above.
- ODI’s FAQ still says payments become final after two years. The statute, as amended by SB 162, says one year.
Sources
Billing for a practice with more than one location? See how we report denials and A/R by location.
A-Z was built inside a four-location practice. The free tools on this site are the ones we use ourselves.