11 N.C. Admin. Code 18.0112

Current through Register Vol. 39, No. 9, November 1, 2024

Section 18 .0112 - CLAIMS PAYMENTS

In order to assure that all valid claims for payments for benefits provided are paid within a reasonable time, the following standards apply:

(1) Each MEWA shall pay within 30 days of receipt by the MEWA or its administrator, if applicable, all valid claims for benefits.

(2) If the MEWA requires additional information, the MEWA shall request such additional information in writing within the 30-day period; and upon receipt of the additional information, the claim shall be paid within 30 days of receipt of the additional information.

(3) If the claim is denied, the MEWA shall provide the reason or reasons for the denial in writing to the claimant and the claimant's health care provider.

11 N.C. Admin. Code 18 .0112

Authority G.S. 58-2-40(1); 58-49-40; 58-49-50;
Eff. July 1, 1992;
Pursuant to G.S. 150B-21.3A, rule is necessary without substantive public interest Eff. December 16, 2014.

Authority G.S. 58-2-40(1); 58-49-40; 58-49-50;
Eff. July 1, 1992.