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How Providers Can File a Prompt Payment Complaint

The Department of Financial Services investigates insurance complaints involving licensed insurance entities. This Department cannot: Act as your lawyer, give legal advice, recommend, or rate insurers.

Before contacting this Department regarding an alleged prompt pay violation, please do the following:

  1. Contact the insurer or HMO to verify that the claim was received.
  2. Make every effort to determine the type of coverage. If the patient is covered by a self-funded plan or Medicare this Department lacks jurisdiction to assist.
  3. Review your records to ensure claim has not been paid or denied.
  4. If the insurer or HMO has requested additional documentation and you have not supplied it, the claim is not delinquent and should not be submitted as a complaint.

You can file a No Fault, Workers Compensation or Prompt Pay Complaint complaint using our Online Complaint Form. You will receive immediate confirmation and be assigned a file number.

You will have one hour to process the complaint form. If you do not complete the form within one hour you will be prompted to refresh and the information you have entered before refreshing will be lost.

The form will contain a series of questions. If you do not understand any of the requested information, you can click on the question and a help box will appear to offer an additional description.

Updated 02/28/2013

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