A hospital submits a health claim to an insurer licensed in North Carolina. Within what period after receiving the claim must the insurer pay it, deny it, or request additional information?

Why D is correct

Under G.S. 58-3-225(b), the insurer must pay, deny, or request information within 30 calendar days after receiving a claim, and a claim is presumed received five business days after mailing or electronic transmission. Under G.S. 58-3-225(e), late payments bear interest at 18% per annum, giving insurers a real financial incentive to decide claims promptly.

Why the other options are wrong

• A) Ninety days is the window for the insurer to deny a claim when requested information is not received under G.S. 58-3-225(c), not the initial claim-decision deadline.
• B) Fifteen days is the time an insurer has to furnish claim forms after notice of claim under G.S. 58-51-15(a)(6), not the pay-deny-request deadline.
• C) Sixty days relates to provider claim status reporting under G.S. 58-3-225(g), not the initial decision window.

Memory hook

Thirty days to pay, deny, or ask - then 18% interest if you dawdle.

Why B is correct

Under G.S. 58-3-225(b), the insurer must pay, deny, or request information within 30 calendar days of receiving a claim, and a mailed or electronically transmitted claim is presumed received five business days after it was sent. If the insurer pays late without reasonable cause, G.S. 58-3-225(e) imposes interest at 18% per annum on the unpaid amount, so the deadline carries real financial consequences.

Why the other options are wrong

• A) 15 days is the window for the insurer to furnish claim forms after notice of claim under G.S. 58-51-15(a)(6), not the pay-or-deny deadline.
• C) 60 days is the trigger for a claim status report on an unpaid, undenied provider claim under G.S. 58-3-225(g), not the initial decision window.
• D) 90 days is the period after which information requested by the insurer is treated as not received, allowing denial under G.S. 58-3-225(c).

Memory hook

Pay, deny, or ask within 30 days - late money costs 18% a year.