The short answer
Under C.R.S. 10-16-106.5, a Colorado carrier must pay, deny or settle a clean claim within 30 calendar days of receipt if it was submitted electronically, or 45 calendar days if it was not. Miss that, and the carrier owes the covered benefit plus interest at 10% a year on the total amount ultimately allowed, counted from the date payment was due. If a claim is still unresolved 90 days after the carrier received it, the statute adds a penalty of 20% of the allowed amount, imposed on day 91. It covers carriers regulated by the Colorado Division of Insurance, not self-funded employer plans.
Which claims qualify
- A clean claim. The statute defines it as a claim "submitted to a carrier on the uniform claim form" with "all required fields completed with correct and complete information, including all required documents" (subsection 2). A claim that needs more information is not clean.
- Not periods of unpaid premium. Expenses from a period when premiums were delinquent are excluded, except where other law requires otherwise (subsection 2). Claims for services after the first month of a member's three-month grace period are outside the section, and so are workers' compensation claims (subsection 8).
- Claims that need more information. The carrier must ask in writing within 30 calendar days of receiving the claim, and the provider then has 30 calendar days to send what was asked for (subsection 4(b)). A carrier that misses its own step in that timeline owes the same interest (subsection 5(a)).
- Plans the state regulates. The statute binds carriers, which Colorado law defines as entities providing coverage "subject to the insurance laws and rules of Colorado" (C.R.S. 10-16-102(8)). Self-funded employer plans are not: the Division of Insurance says they are "not subject to state insurance laws or jurisdiction." A large insurer's name on the card can mean it only administers a self-funded plan, so check the plan type, not the logo.
- Paid to the provider. Interest is owed to the insured or to the health-care provider "with proper assignment" of benefits (subsection 5(a)).
Health First Colorado (Medicaid) and Original Medicare run on their own payment and filing rules, which this article does not cover. Medicare Advantage plans follow federal rules, which override state law other than licensing and solvency (42 CFR 422.402).
When the clock starts
Both deadlines count from receipt, so the receipt date is the number every interest request rests on. The statute sets it by how the claim was sent (subsection 2.7):
- Electronic. The claim is presumed received on the date of electronic verification of receipt by the carrier or its clearinghouse, which must send that confirmation within one business day.
- Paper, fax or hand delivery. The carrier must list the claim as received on its own confirmation system within ten business days, and the claim counts as received on the date it is listed. If it never appears, the provider can resubmit through the carrier's fax process, and the fax acknowledgment date becomes the receipt date.
Note whose verification counts: the carrier's or the carrier's own clearinghouse. An acceptance from your own clearinghouse may show only that the file left your hands, so keep the payer-level acknowledgment (the 277CA) as well.
Keep that acknowledgment for every claim, matched to the claim number. Without it there is no date to count from, and no way to show the claim was clean when it arrived. A claim that was rejected rather than accepted never started the clock at all, which is why the acceptance report matters.
The interest math
Illustrative arithmetic, not legal advice.
- Clean electronic claim received
- 1 March
- Allowed amount
- $1,000
- Payment due
- 31 March
- Paid
- 30 April, 30 days late
Interest: $1,000 × 10% × 30/365 = $8.22
- Same claim, received
- 1 March
- Day 91 after receipt
- 31 May
- Penalty, 20% of the allowed amount
- $200
Penalty imposed on 31 May: $200. Interest has also been running since 31 March. The statute does not say whether the penalty replaces it, so show each one separately when you ask.
Three details change the number. The deadlines are calendar days, not business days. The base is the total amount ultimately allowed on the claim, not the billed charge and not just the carrier's share, so on its plain wording it includes the patient's cost sharing. And "ultimately" matters: if the claim is reprocessed and allows more, the base rises with it.
One late claim is small. A year of them is not: 400 claims like the first come to $3,288. And a carrier that pays late as a pattern is telling you something worth taking to the regulator, not just the claims desk.
How to request it
Check whether it was already paid
Some carriers pay interest with the claim. In 835 data it shows as a claim-level interest amount (AMT, qualifier I) and, when it changes the payment, as a provider-level adjustment with code L6 (X12 interpretation 1324). Penalties can also arrive later: the statute lets carriers pay them quarterly, or once a provider's total passes $10.
Pull the late-paid clean claims
From your 835s and acknowledgments, list each claim's receipt date, payment date and allowed amount, then flag every clean claim paid after day 30 (electronic) or day 45 (any other way). Set aside claims the carrier pended with a written request for more information; their timeline runs under subsection 4(b).
Ask in writing
Cite C.R.S. 10-16-106.5, list the claim numbers, and attach proof of receipt, the payment dates and your calculation for each claim. Send it to the address the carrier gives for provider disputes, and keep proof of the date you sent it.
Escalate a pattern
If a carrier keeps paying late or ignores the request, file a complaint with the Division of Insurance. The Division acts on these: in 2022 it fined Bright Health $1 million after more than 100 consumer and provider complaints, including failure to pay provider claims as Colorado law requires.
Keep filing on time
Prompt pay doesn't extend a payer's filing limit or appeal deadline, so check each claim's filing window on its own schedule.
Where this fits in AR
Interest owed is money owed, and it sits in the same remittances as underpayments and denials. A practice that works its AR claim by claim already has every date the calculation needs: receipt from the acceptance report, payment from the 835, the allowed amount from the remittance.
The hard part is noticing. A late-paid claim looks closed, so nobody reviews it, and the interest is never requested. Run the check by payer, quarterly, and the carriers that pay late as a habit show up on their own. The same review turns up the claims that matter more: denials still inside their window, short payments, and claims that were never accepted at all. The rules each Colorado payer runs on, including Health First Colorado's 365-day limit, are set out in AR recovery for Colorado practices.
Texas works differently: its penalties are figured on billed charges minus the contracted rate. See how Texas prompt-pay penalties work.
Statute last checked: 22 Oct 2026
