Late payments from health plans can slow cash flow and impact operations. Many states have strict prompt pay laws requiring claims to be processed and paid within defined timelines. When deadlines are missed, providers and facilities are entitled to penalties and interest, but pursuing these payments can be complex and time consuming. At Gryphon Healthcare, we proactively audit claims, file formal notices, and escalate late payments to recover every dollar owed.
Real-World Impact of Prompt Pay Violations
Many providers and facilities experience delays in receiving payments, which can lead to cash flow challenges. Late payments can extend to weeks or even months past the mandated timelines, and penalties or interest often go unclaimed, leaving substantial revenue on the table. By identifying and pursuing these violations, Gryphon ensures that clients capture the full financial benefits they are legally owed.
What Is Prompt Pay?
Prompt pay laws are state-level regulations designed to ensure that claims are paid within specified timelines. They apply to both providers and facilities and are intended to guarantee accountability and fair treatment from payors. When payors fail to meet these deadlines, late payments may trigger penalties and interest, giving providers and facilities legal recourse to recover owed amounts.
How Prompt Pay Works in Practice
The process begins by auditing claim timelines against state-mandated deadlines to identify any violations. Once a potential issue is detected, Gryphon files formal notices with the payor for late payments and then escalates unpaid claims until full payment is received.
Why Prompt Pay Matters for Providers and Facilities
Prompt pay is crucial for protecting revenue and maintaining healthy cash flow. It reduces the administrative burden for providers and facilities by offering a structured path for recourse when payors miss deadlines. Enforcing prompt pay laws also ensures that payors remain accountable, preventing small delays from snowballing into significant financial losses that could impact provider or facility operations.
State-by-State Considerations
Prompt pay laws vary from state to state, with each having its own timelines, penalties, and enforcement mechanisms. Gryphon’s team stays current on evolving regulations, ensuring we are prepared to support providers and facilities in any state where prompt pay laws apply. By understanding the nuances of each state’s requirements, we can tailor our approach to maximize recovery opportunities for every client.
The Gryphon Difference in Prompt Pay
At Gryphon, our team is focused on providing relentless follow-through across all claims. Our specialists have deep knowledge of state-specific laws, guidelines, and payor practices, allowing them to proactively audit cases, file notices, and escalate unpaid claims. We pursue every cent owed, including penalties and interest, and act as an extension of our clients’ teams, protecting revenue with precision and persistence. That is the Gryphon Difference.
Conclusion
Prompt pay laws are designed to protect providers and facilities, but capturing owed penalties and interest requires expertise, persistence, and knowledge of state-specific rules. Gryphon Healthcare delivers the guidance and execution needed to maximize revenue and safeguard financial health for our clients.
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