How Long Should It Take to Get Paid by Insurance?

This is a question a lot of physicians ask when they’re not sure if a slow payment is normal or a sign of a problem.

The legal requirement

Under the National Association of Insurance Commissioners (NAIC) model regulation, which most states have adopted, insurers are required to pay or deny a clean electronic claim within 30 days. For paper claims, the window is typically 45 days.

Medicare has a faster standard: clean electronic claims must be processed within 14 business days.

These are maximum timeframes, not targets. Many clean claims are paid in 7 to 14 days.

What actually slows payments down

The 30-day clock only runs on clean claims. If your claim has an error, missing information, or triggers a review, the clock stops until the issue is resolved. That’s why the same claim might get paid in 10 days one month and sit for 60 days the next, if something is different about how it was submitted.

The most common causes of slow payment:

• Claim submitted with an error that triggered a request for additional information
• Payer placed the claim in a review queue (common with high-cost procedures)
• Prior authorization issue that wasn’t resolved before billing
• Eligibility problem that prevented the claim from matching the patient’s record
• Simply nobody following up on claims that entered a payer hold status

What’s a reasonable timeline to expect?

For a well-run billing process:

• Commercial insurance, clean claim: 14 to 21 days
• Medicare, clean electronic claim: 7 to 14 days
• Medicaid: 14 to 30 days, sometimes longer depending on the state

If you’re routinely waiting 45 to 60 days for commercial insurance payments on standard visits, your claims are probably not going in clean, or nobody is following up.

How to track this for your own practice

Your billing software or billing company should be generating an AR aging report that shows the average age of your outstanding claims. If your average days in AR is above 40, payments are taking longer than they should.

If you see a lot of claims stuck in the 60-plus day column with specific payers, that’s a signal to investigate those payer relationships. Sometimes it’s a billing error pattern. Sometimes a payer is systematically slow on specific procedure codes. Both are fixable with the right follow-up.

If your claims are consistently taking too long to pay, a billing audit from FluxCura can identify exactly where the slowdown is happening. Request your free audit.