Connecticut Prompt Pay Law: 5 Key Rules for Providers
The Connecticut prompt pay law sets deadlines for how fast health insurers must pay provider claims. Status is current as of October 17, 2026. This post is operational guidance, not legal advice. See our state billing guides and the Resources hub for related topics.
What the Connecticut prompt pay law requires
Slow payment hurts small practices most. The Connecticut prompt pay law gives you a clear clock to hold insurers to.
The rule sits in Conn. Gen. Stat. 38a-816(15), part of the state’s unfair insurance practices act. For paper claims, payment is due within 60 days after the insurer receives the proof of loss form. For electronic claims, payment is due within 20 days. Late payments accrue interest at 15 percent per year, in addition to other penalties.
Incomplete claims and the notice clock
If a claim lacks needed information, the insurer must send written notice of the deficiencies. For paper claims, notice is due within 30 days of receipt, and payment within 30 days after the missing information arrives. For electronic claims, those windows are 10 days each. Reply to every request fast and keep proof of when you sent it. Under the Connecticut prompt pay law, the payment clock follows the statute’s notice steps, so record each date. Write down who asked, what they asked for, and when you answered.
Who the Connecticut prompt pay law covers
The statute applies to insurers and other entities that pay health care providers under an insurance policy. A 2008 Insurance Department bulletin addressed it to health insurers and health care centers. Fully insured plans fall under state insurance law. The NAIC says self-funded ERISA plans (Employee Retirement Income Security Act plans that pay claims from their own assets) are exempt from state regulation. Ask the payer which type of plan the patient has. Medicare follows federal rules, and Medicaid is separate. Our in-network vs out-of-network guide covers contract differences.
Legitimate disputes and clean claims
Late-payment liability does not apply if the Insurance Commissioner finds a legitimate dispute over coverage, liability, or damages, or finds that the claimant caused the loss by fraud. The 2008 bulletin lists reasons it treats as legitimate, such as medical necessity, coordination of benefits, dependent eligibility, and suspected fraud. It also says other delays need the Commissioner’s approval first. That bulletin describes a 45-day period, which predates the current statute text, so rely on the statute for timing.
How to file a complaint
The Connecticut Insurance Department takes complaints through the NAIC online form, by email, or by a mailed complaint form, per its complaint page. Gather the claim number, dates, and your correspondence first. A short, factual timeline works best. State the claim, the dates, and what the statute requires.
| Payer type | Where the rule lives | What to check |
|---|---|---|
| Private insurance | State prompt pay statute and the plan contract | The payment deadline and what the plan calls a clean claim |
| Medicaid | State Medicaid agency and the managed care plan contract | Filing and payment timelines, which vary by state |
| Medicare | CMS and your Medicare Administrative Contractor | Federal claim timing rules, separate from state law |
Practical tips for connecticut prompt pay law
Log the receipt date of every claim and the 20-day and 60-day marks. Build a report that flags unpaid claims before those dates. When you review the connecticut prompt pay law, confirm whether the plan is insured or self-funded before you cite it. Reference the connecticut prompt pay law in your appeal only after you confirm the plan type. Escalate claims that pass the deadline with a dated written request that cites the statute. Keep a simple tracker with the claim number, submission date, notice date, and payment date. Review it weekly so no claim ages unnoticed. Train billing staff on the deadlines so everyone reads them the same way. Use the insurance companies contact directory to reach the right payer line, and see our credentialing service for network setup.
Where MCM South helps
MCM South Medical Billing Service, LLC bills for psychotherapists and psychiatrists in Georgia (GA), Massachusetts (MA), Connecticut (CT), Texas (TX), Florida (FL), New York (NY), Colorado (CO), Tennessee (TN), North Carolina (NC), and Illinois (IL). We follow up on unpaid claims and denials. Get a Free Quote or Schedule a Consultation.
Keep learning: read the Billing Terms Glossary, the CPT and E/M code guide, the insurer contacts by state, and private practice management tips.
More from MCM South: Connecticut insurance companies contact guide; clean claim glossary entry; timely filing glossary entry.
FAQs
How fast does the connecticut prompt pay law require electronic claims to be paid?
Within 20 days after receiving the proof of loss form, under Conn. Gen. Stat. 38a-816(15). Paper claims have 60 days.
What interest applies to late claims?
The statute provides 15 percent per year on late payments, in addition to other penalties.
Does the connecticut prompt pay law apply to self-funded employer plans?
Generally no. The NAIC says self-funded ERISA plans are exempt from state regulation. Verify each plan’s funding type.
Where do I file a complaint about slow payment?
Use the Connecticut Insurance Department complaint page, which offers an online NAIC form, email, and a mailed form.
