The contractor must
pay interest on clean, non-PIP (FIs) claims for which it does not make payment
within the payment ceiling specified in § 80.2.1.1, provided payment is due on
such claim. The interest rate and formula for calculation are shown above. The
interest rate is determined by the rate applicable on the carrier or FI’s
payment date.
The contractor applies interest to the net payment amount after all applicable
deductions are determined (e.g., deductible, copayment, and/or MSP). Interest
is rounded to the nearest penny.
A. Reporting Interest Payment on Remittance Record
See 100-22 for remittance advice completion instructions
B. Payment Made to Beneficiary
If interest is paid on a claim for which payment is made directly to the
beneficiary, the contractor adds the following messages on the beneficiary
notice:
“Your payment includes interest since we were unable to process your claim
timely.”
C. Claims Paid Upon Appeal
Interest payments are not payable on clean claims initially processed to denial
and on which payment is made subsequent to the initial decision as a result of
an appeal request. This applies to appeals where more than the applicable
number of days elapsed before an initial denial, but the claim was later paid
upon appeal. Where an appeal of a previously paid claim results in increased
payment FIs follow the following section.
