State RegulationsGA specificDifficulty 2/5
A Georgia hospital submits a paper claim to an insurer for a covered service. Under the surprise billing provisions of Georgia's unfair claims practices article, the insurer must pay the provider within:
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Answer & full 3-part explanation (select an option above, or peek)
Why D is correct
Under O.C.G.A. § 33-6-34(15)(B), failing to pay a provider within 30 calendar days for paper claims — or within 15 working days for electronic claims — is an unfair claims settlement practice. The formatting distinction matters: paper claims get the longer calendar-day window, electronic claims the shorter working-day window. Missing the deadline exposes the insurer to disciplinary exposure under the unfair claims article.
Why the other options are wrong
- A) 15 calendar days matches neither deadline; paper claims get 30 calendar days.
- B) 30 working days is not a Georgia deadline; the paper-claim window is measured in calendar days.
- C) 15 working days is the electronic-claims payment window, not the window for paper claims.
Memory hook
Paper is slower: 30 calendar days for paper, 15 working days for electronic.