Colorado Prompt Pay Law: 5 Key Rules for Claims
The Colorado prompt pay law sets deadlines for how fast an insurance carrier must pay, deny or settle your claims. Status is current as of October 17, 2026. This is operational guidance, not legal advice. For real exposure, talk to a health care attorney.
What the Colorado prompt pay law says
The rule is Colorado Revised Statutes section 10-16-106.5. You can read it at Colorado Public Law and Justia. Both are unofficial copies, so check the official statute before relying on it. The law covers timely payment of routine, uncontested claims for patients and providers. In plain terms, the Colorado prompt pay law gives you a clock to hold carriers to. It does not make every payer follow it, so read the exemptions below. Know it before you build your follow-up routine.
Colorado prompt pay law deadlines
- Clean claim, filed electronically: paid, denied or settled within 30 calendar days of receipt.
- Clean claim, filed by any other means: 45 calendar days of receipt.
- Other claims: 90 calendar days, absent fraud.
A clean claim uses the uniform claim form, with every required field and document completed correctly. A claim that needs more information is not clean. File electronically whenever you can, because the electronic clock is 15 days shorter. That single choice is the easiest win under the Colorado prompt pay law. Submit through a clearinghouse that gives you a dated acceptance report, and save it.
Interest and penalties for late payment
If a carrier misses the clean-claim deadline, it owes interest at 10% a year on the total amount ultimately allowed, running from the date payment was due. If a claim is still unresolved after 90 days, the carrier owes a penalty of 20% of the amount ultimately allowed, imposed on day 91. Keep dated proof of when each claim was received. A payer will often claim it received a claim later than you did. A clearinghouse acceptance report and the payer’s own receipt date are your best evidence. Interest only matters if you can show the due date, so write it on the claim record when you submit.
Incomplete claims and your response window
Within 30 calendar days, the carrier must tell you in writing what extra information it needs. You then have 30 calendar days to send it. If you miss that window, the carrier may deny the claim. You can still resubmit or appeal. Our Billing Terms Glossary explains terms like clean claim and corrected claim.
Who the Colorado prompt pay law does not protect
Private insurance
The statute reaches carriers regulated in Colorado. It excludes workers’ compensation claims and certain claims during a three-month grace period.
Self-funded employer plans
The Colorado Division of Insurance states that self-funded ERISA plans are not subject to state insurance laws. That guidance is dated 2009, so reconfirm. Oversight of those plans rests with the U.S. Department of Labor. Ask on every benefits check whether the plan is fully insured or self-funded. The member ID card often says. If the payer will not tell you, note that in the chart and treat the Colorado prompt pay law as unconfirmed for that plan.
Medicare and Medicaid
Medicare follows federal rules, including a 12-month filing limit. Medicaid managed care has its own contract terms. Do not apply this statute to either without checking.
How to complain to the Division of Insurance
The Colorado Division of Insurance Consumer Services team takes complaints about insurance companies. Use “File a Complaint” at doi.colorado.gov, per the Division’s annual report. The statute also lets the commissioner investigate provider complaints about improper handling or denial of claims.
| 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 Colorado prompt pay law
Build a simple tracker for colorado prompt pay law deadlines. Log the submission date, the clearinghouse acceptance date and the 30-day mark. At day 30, call the payer and ask for the claim status in writing. Mention the colorado prompt pay law only after you have confirmed the plan is fully insured. Our Insurance Companies Contact page lists payer contacts, and your in-network vs out-of-network status affects your contract rights too.
Where MCM South helps
MCM South Medical Billing Service, LLC bills for psychotherapists and psychiatrists only. We serve Georgia (GA), Massachusetts (MA), Connecticut (CT), Texas (TX), Florida (FL), New York (NY), Colorado (CO), Tennessee (TN), North Carolina (NC) and Illinois (IL). If you want a second set of eyes on your claims, Get a Free Quote or Schedule a Consultation.
Keep learning: read our State & Regional Billing Guides hub, browse Resources, and see Practice Management & Business Tips.
More from MCM South: Colorado insurance companies contact guide; clean claim glossary entry; timely filing glossary entry; underpayments guide; claim status inquiry guide; Georgia prompt pay guide.
FAQs
How many days does a Colorado insurer have to pay a clean claim?
30 calendar days for electronic claims and 45 calendar days for claims filed by other means, counted from receipt.
What interest does Colorado require on late claims?
Ten percent a year on the total amount ultimately allowed, from the date payment was due. A 20% penalty applies after 90 days.
Does the law apply to self-funded employer plans?
Generally no. The Colorado Division of Insurance says self-funded ERISA plans are outside state insurance law. Confirm the plan type first.
Where do I file a complaint about a late-paying insurer?
Use the File a Complaint link at doi.colorado.gov. Keep claim dates, receipts and payer correspondence ready.
