Under California's prompt-payment statute for health insurance, an insurer must pay or contest a 'clean' claim within how many working days of receipt?
Explanation
California Insurance Code §10123.13 (and §10350.5 for disability/health) requires an insurer to reimburse or contest a clean claim from a contracted health provider within 30 working days of receipt for paper claims and 30 calendar days for electronic claims. If the insurer fails to act within that window, interest at 10% per year (or 15% for certain emergency claims under §10123.147) accrues automatically on the unpaid amount. The 15-working-day window limited to contracted network providers is too short and is not the statutory rule. The 90-calendar-day window is closer to the federal Medicare standard, not the CA private-insurance rule. And the 6-month window is far beyond statute. The prompt-payment rules are part of California's consumer-protection regime that prevents insurers from indefinitely deferring legitimate provider claims.
Law Reference: Cal. Ins. Code §10350.5 (prompt payment of claims)This topic, taught in full in the California Life & Health Insurance Producer Exam guide. California Life & Health Insurance Producer Exam — Complete Study Guide (2026) — PDF + EPUB, $19.99 · 14-day refund →
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