Massachusetts Prompt Pay Law: The 45-Day Rule for Therapy Claims
The Massachusetts prompt pay law gives insurers 45 days to act on a completed claim form. If you bill for therapy or psychiatry in Massachusetts, that clock decides when you should start following up. This guide explains where the 45-day rule lives, how interest works, who is outside it and how MassHealth and Medicare deadlines differ. Check each statute before you rely on the Massachusetts prompt pay law. This is operational guidance, not legal advice.
Where the Massachusetts prompt pay law is written
Massachusetts has no single prompt pay statute for all insurers. The 45-day rule appears in two chapters of the General Laws:
- M.G.L. c. 176G, section 6 covers health maintenance organizations (HMOs). Contracts with participating providers must set a deadline of 45 days after the HMO receives completed forms.
- M.G.L. c. 176I, section 2 applies the same rule to preferred provider arrangements.
Within 45 days the insurer must pay the claim, explain in writing why it will not pay, or ask for missing information. Under the Massachusetts prompt pay law, both sections say “completed forms,” not “clean claim,” so send every field and attachment the payer requires.
We did not review the indemnity and Blue Cross chapters, so do not assume these two sections cover every insurer. Read your payer contract for the exact payment terms.
Interest under the Massachusetts prompt pay law
Interest starts 45 days after the insurer receives the completed forms. It accrues at 1.5 percent per month, capped at 18 percent per year. It does not apply to claims under a fraud investigation. Keep your submission dates and clearinghouse reports, and ask for interest in writing when a claim is late.
What the Massachusetts prompt pay law does not cover
- Self-funded plans. Mass.gov says self-funded plans are generally not subject to state insurance laws, though federal laws apply. See the Division of Insurance consumer alert.
- Medicare and MassHealth. The Division of Insurance (DOI) has no authority over Medicare, MassHealth or the Group Insurance Commission.
- Claim formats. Under M.G.L. c. 176O, section 5A, insurers must accept standard HIPAA claim formats and current coding, but that section sets no payment deadline.
No Massachusetts statute we reviewed sets a commercial filing deadline for providers. Your contract with each payer sets that limit, so read it.
Private insurers, Medicare and MassHealth: three different clocks
| Payer type | Who sets the rule | What to know |
|---|---|---|
| Private insurer (HMO or preferred provider plan) | Massachusetts law and your contract | 45 days after completed forms to pay, explain or request information. Filing limits come from your contract. |
| Medicare | Federal rules | Claims must reach the MAC within one calendar year (12 months) of the date of service, per CMS MLN006976. |
| MassHealth fee-for-service | MassHealth | Initial claims must arrive within 90 days of the service date, per MassHealth billing timelines. Managed care plans set their own limits. |
MassHealth adds more detail: if another insurer must pay first, the 90 days run from that insurer’s explanation of benefits date. Appeals of 853 and 855 denials are due within 30 days of the remittance date.
How to follow up on a late claim in Massachusetts
- Confirm the claim reached the payer and note the date the completed forms arrived.
- Call provider services and get a reference number. Our Massachusetts insurance companies contact guide lists the numbers.
- If 45 days passed, write to the insurer and cite the receipt date and the interest you believe is owed.
- If that fails, consider the Division of Insurance. Its complaint page is written for consumers, so ask the DOI whether it accepts a provider complaint about late payment before you file. See how to file an insurance complaint.
The DOI lists a Consumer Services Unit line at 617-521-7794, Monday to Friday, 8:45 a.m. to 5:00 p.m. It cannot give legal advice or decide medical necessity.
Where MCM South helps
MCM South Medical Billing Service bills for psychotherapists and psychiatrists, and denied claim follow-up is part of that work. We currently serve practices in Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. If tracking the Massachusetts prompt pay law deadlines is taking your week, get a free quote or schedule a consultation.
Keep learning: the insurance companies contact by state directory, the billing terms glossary, the CPT and E/M code guide, insurance credentialing, credentialing and network status, the mental health billing FAQ and who we serve. Confirm each deadline with the source.
FAQs
How long does an insurer have to pay a claim under the Massachusetts prompt pay law?
HMO and preferred provider contracts must set a deadline of 45 days after the insurer receives completed forms, under M.G.L. c. 176G, section 6 and c. 176I, section 2.
What interest applies under the Massachusetts prompt pay law?
Interest accrues from day 45 at 1.5 percent per month, capped at 18 percent per year. It does not apply to claims under a fraud investigation.
Does the Massachusetts prompt pay law cover MassHealth?
No. The Massachusetts prompt pay law does not reach MassHealth. The Division of Insurance has no authority over MassHealth, which sets its own billing timelines.
Do self-funded plans follow the Massachusetts prompt pay law?
Generally no. Mass.gov says self-funded plans are generally not subject to state insurance laws.
