How long do insurance companies have to pay a clean claim?

Every clock below starts when the payer receives a clean claim, so check that first. Medicare doesn't treat a rejected claim as received until it comes back corrected, and in Texas an insurer may ask once, within 30 days, for records it needs, which can push its deadline to 15 days after it gets them.

Medicare must pay or deny a clean claim within 30 days of receipt, counting from the day after it arrives. It can't pay an electronic claim before the 14th day or a paper claim before the 29th, so a clean electronic claim should pay between day 14 and day 30. After day 30 it owes interest at the Treasury prompt payment rate, 4.75% a year for July to December 2026. That's about 13 cents on a $100 claim paid ten days late, and nothing on a claim that was denied first and paid on appeal. Medicare Advantage plans owe the 30-day standard, 95% of clean claims, to providers without a contract. If you're in network, your contract sets the deadline.

A state Medicaid agency must pay 90% of clean claims from practitioners within 30 days of receipt, 99% within 90 days and the rest within 12 months (42 CFR 447.45). Medicaid managed care plans must meet the same 90% and 99% standards unless you and the plan agree a different schedule in your contract (447.46). Both are shares of all claims, so a state can comply while your claim is still late.

Insured commercial plans fall under state law, and Texas is a useful example because its rules have teeth. An HMO or insured PPO must decide and pay an in-network clean claim within 30 days if it was filed electronically and 45 days if on paper (Texas Insurance Code 1301.103 and 843.338). Paying late costs the insurer the contracted rate plus a penalty: the lesser of half the gap between your billed charge and the contracted rate, or $100,000. The penalty doubles, to a maximum of $200,000, when payment is more than 45 days late, and past 90 days 18% annual interest is added, which goes to the state rather than to you. The same law gives you 95 days from the date of service to file.

The catch is who the law covers. TDI regulates HMOs and fully insured plans, and says those are less than a quarter of the health insurance sold in Texas. Self-funded employer plans pay claims from the employer's own funds rather than buying insurance, and they cover 67% of workers with employer coverage nationally (KFF, 2025). For those patients, the payment terms in your network contract are usually the only clock you can enforce. TDI's rule of thumb: if the patient's ID card says 'TDI' or 'DOI' on the front, complain to TDI.

To put this to work, run a payment lag report by payer showing the share of paid dollars that arrived within 30, 60 and 90 days of claim acceptance. Where a payer misses its legal or contract deadline on clean claims, send a written demand citing the section, bill the penalty where the law gives you one, and file the complaint. If the lag is on your side, with claims going out late or bouncing back, start with the most common billing errors.