Pennsylvania gives payers 45 days to pay a clean claim and adds 10% annual interest when they miss it. Since January 1, 2024, that interest rule applies to commercial insurers and HMOs but not to Medicaid (HealthChoices) or CHIP plans, a change many summaries still miss.
To see what a late Pennsylvania payer owes on a specific claim, use the prompt pay interest calculator.
Pennsylvania prompt pay at a glance
| Statute | Section 2166 of the Insurance Company Law of 1921 (40 P.S. § 991.2166) |
|---|---|
| Electronic clean claim | Pay within 45 days of receipt |
| Paper clean claim | Same 45 days. The statute does not distinguish them. |
| Late payment | 10% per year (commercial insurers and HMOs only) |
| Regulator for complaints | Pennsylvania Insurance Department |
The statute
The prompt-pay rule is section 2166 of Article XXI of the Insurance Company Law of 1921, added by Act 68 of 1998. The Insurance Department’s implementing regulation is 31 Pa. Code § 154.18.
Act 146 of 2022, effective January 1, 2024, restructured section 2166 so that subsection (a) covers “insurers” and a new subsection (a.1) covers Medicaid and CHIP managed care plans. We found no later amendment.
Clean-claim payment deadlines
An insurer must pay a clean claim within 45 days of receipt (§ 2166(a)). Medicaid and CHIP managed care plans have the same 45 days under § 2166(a.1).
Under the regulation, a claim counts as paid when the check is mailed or the electronic transfer is made, and a re-adjudicated claim starts a new 45-day period (31 Pa. Code § 154.18). Plans must answer claim status inquiries within 45 days of submission, or within 30 days of an inquiry made after that.
Not verified: the statute and regulation say “days” without specifying calendar or business days.
Interest and penalties on late payment
When an insurer misses the deadline, “interest at ten per centum (10%) per annum shall be added to the amount owed on the clean claim” (§ 2166(b)). Interest runs from the day after the payment due date until the claim is paid, and amounts under $2 need not be paid. The regulation requires interest to be paid within 30 days of paying the claim.
Since Act 146, subsection (b) applies only to “insurers,” and the definition of insurer excludes entities operating as Medicaid or CHIP managed care plans. The Department may impose a penalty of up to $5,000 per violation.
Which payers the law covers
- Commercial fully insured plans: Covered. “Insurer” includes entities licensed by the Insurance Department issuing individual or group health policies (§ 2102).
- HMOs: Covered. The insurer definition includes policies issued under the Health Maintenance Organization Act.
- Medicaid managed care plans: Covered by the 45-day rule under § 2166(a.1), but not by the statutory 10% interest since January 1, 2024.
- Self-funded ERISA plans: Not covered. They are not licensed insurers’ policies, and state regulation of them is generally preempted by ERISA § 514.
Auto and workers’ compensation claims are expressly excluded (31 Pa. Code § 154.18).
How to file a prompt-pay complaint
The regulation requires a provider to contact the insurer about the claim first, then sets what a complaint to the Department must contain (31 Pa. Code § 154.18(f) to (h)). The Insurance Department’s complaints page directs complaints to its online CSO Portal and lists 1-877-881-6388.
Not verified: provider-specific filing instructions, because the Department’s former provider complaint page now redirects to its home page and its Act 68 fact sheet returns an error. Fax and mailing details circulating online could not be confirmed. HealthChoices plan disputes run through the Department of Human Services agreement, and we found no DHS provider prompt-pay complaint channel.
How prompt pay interacts with timely filing
We found no Pennsylvania statute or Insurance Department regulation setting a minimum filing window, so the deadline comes from the payer contract, or for HealthChoices, the DHS agreement. The 45-day payment clock starts at receipt of a clean claim and resets when a paid claim is re-adjudicated on new information (31 Pa. Code § 154.18(d)), but the regulation does not extend any contract filing deadline for a corrected claim. Our 2026 timely filing guide compares filing windows by payer.
What we could not verify
- Provider-specific complaint instructions, including the fax number, mailing address, and the spreadsheet rule for more than 10 claims that appear in older materials.
- Whether the CSO Portal has a provider prompt-pay complaint option.
- Day type for the 45-day period.
- Any interest HealthChoices or CHIP plans owe under the DHS contract.
- The self-funded ERISA exclusion, which is an inference from the definitions plus ERISA § 514.
- Treatment of the state employee plan (PEBTF).
- Whether the Department has updated § 154.18 since Act 146. The regulation still uses the older terms.
Sources
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