Georgia Prompt Pay Law: How Fast Insurers Must Pay Therapy Claims
The Georgia prompt pay law sets how fast an insurer must pay a claim or tell you why it will not. For a therapist or psychiatrist, it is the rule behind every “where is my payment?” call. This guide explains the deadlines in O.C.G.A. 33-24-59.5, the interest rate, who the law covers and how to escalate to the Georgia Office of Commissioner of Insurance and Safety Fire (OCI). Check the statute and OCI page before you rely on a Georgia prompt pay law deadline. This is operational guidance, not legal advice.
What the Georgia prompt pay law requires
Under O.C.G.A. 33-24-59.5, an insurer that receives a claim must pay it or send notice of the reasons for nonpayment within 15 working days for electronic claims. For paper claims the deadline is 30 calendar days. See the statute text for the exact wording.
- If the insurer needs more information, it must itemize the missing documents.
- If only part of a claim is disputed, the insurer must still pay the undisputed part.
- Once you send everything requested, the insurer gets another 15 working days (electronic) or 30 calendar days (paper) to pay or issue a written denial with reasons.
A claim sent to a claims administrator counts as received by the insurer. That means a clearinghouse or third-party administrator date matters, so keep your submission reports.
Interest and penalties under the Georgia prompt pay law
Late payment accrues interest at 12 percent per year on the amount due. The Insurance Commissioner may impose an administrative penalty only if an insurer processes fewer than 95 percent of its claims in a standard financial quarter within the deadlines. So the penalty targets patterns, not a single late claim. Do not count on a per-claim penalty. Track late claims and the interest you may be owed, and ask for it in writing.
Who the Georgia prompt pay law covers
The law applies to insurers adjudicating fully insured business and third-party administrator business. It excludes capitated payment arrangements under managed care plans, Chapter 31 policies, disability income policies and workers’ compensation plans. Other limits on the Georgia prompt pay law matter just as much:
- Self-funded employer plans are generally not subject to state insurance law, and OCI says it has no jurisdiction over self-insured employer plans. See the OCI complaint page and the NAIC overview of ERISA.
- OCI also has no jurisdiction over Medicare or Medicaid, which follow their own rules.
Check the member’s card and your payer contract. If the plan is self-funded, the Georgia prompt pay law may not help you.
Private insurers, Medicare and Medicaid: three different clocks
| Payer type | Who sets the rule | What to know |
|---|---|---|
| Private insurer (fully insured) | Georgia law and your contract | Pay or explain within 15 working days (electronic) or 30 calendar days (paper). Filing deadlines are set in your contract. |
| Medicare | Federal rules | Claims must be filed within one calendar year of the date of service, per the CMS Claims Processing Manual. |
| Georgia Medicaid | Georgia DCH and each plan | Amerigroup’s policy, effective June 3, 2025, sets six months after the month of service for participating providers. See the Amerigroup policy. |
No Georgia statute we reviewed sets a commercial filing deadline for providers, so treat that deadline as contract-specific. Read it in every payer agreement.
How to follow up on a late claim in Georgia
- Confirm the claim reached the insurer and note the receipt date from your clearinghouse report.
- Call the provider line and ask for the claim status, a reference number and the rep’s name. Our Georgia insurance companies contact guide lists the numbers.
- If the deadline passed, write to the insurer. Cite the date received, the deadline and the interest you believe is owed.
- Still stuck? File a complaint with OCI. Its provider route is the Consumer Complaint Portal, which OCI calls the preferred and quickest method. The OCI line is (404) 656-2070 or (800) 656-2298, Monday to Friday, 8 a.m. to 5 p.m. ET. See the OCI complaint information.
OCI sends an acknowledgment with a case number, forwards the complaint to the company and requires a written response. Try to resolve the issue with the insurer first, and keep your records.
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 chasing the Georgia 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. Rules change, so confirm each deadline with the source before you rely on it.
FAQs
How long does an insurer have to pay a claim under the Georgia prompt pay law?
The insurer must pay or send notice of the reasons for nonpayment within 15 working days for electronic claims and 30 calendar days for paper claims, under O.C.G.A. 33-24-59.5.
Is there interest on late claims under the Georgia prompt pay law?
Yes. Late payment accrues interest at 12 percent per year on the amount due.
Does the Georgia prompt pay law cover self-funded plans?
Generally no. The Georgia prompt pay law reaches fully insured plans. OCI says it has no jurisdiction over self-insured employer plans, Medicare or Medicaid.
How do I complain to Georgia regulators about a late insurer?
File through OCI’s Consumer Complaint Portal after you try to resolve the issue with the insurer. OCI forwards the complaint and requires a written response.
