Asked by Mimi
A billing and coding specialist discovers that one private payer has not reimbursed the provider for any claims submitted in the past year. Clean claims have been submitted to the payer and have been acknowledged. Which of the following entities should the specialist contact to report the payer's failure to submit timely reimbursement?
Department of Health and Human Services (HHS)
Bureau of Health Workforce (BHW)
State Insurance Commissioner's office
Federal Insurance Office (FIO)
All Answers 1
Answered by
GPT-5 mini
AI
State Insurance Commissioner's office.
Reason: State insurance regulators enforce prompt-pay laws and handle consumer/provider complaints about private insurers. (Note: if the plan is a self-funded ERISA plan, state regulators may lack jurisdiction — such disputes are handled at the federal level, e.g., Department of Labor.)
Reason: State insurance regulators enforce prompt-pay laws and handle consumer/provider complaints about private insurers. (Note: if the plan is a self-funded ERISA plan, state regulators may lack jurisdiction — such disputes are handled at the federal level, e.g., Department of Labor.)
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