The Illinois Prompt Pay Law requires insurance companies, HMOs and other independent practice associations and hospital organizations to pay capitation amounts and claims within a specific time period. Failure to provide payments within the required time entitles the health care facility or professional to interest. The Prompt Pay Law does not apply to self-insured employers or to trusts, or insurance policies written outside of Illinois. The law does apply in some cases to contracts written outside of Illinois, if the HMO member is a resident of the state and has established a health provider in Illinois.

                The Prompt Pay Law deals with Periodic Payments, and payments that require a claim, bill, capitation encounter data, or capitation reconciliation report.

                Periodic Payments can be made within 60 days after an insured or enrollee has selected a health care professional or facility, or if the date of selection becomes effective (whichever is later). Subsequent payments should be made in accordance with a monthly periodic schedule.

                Payments other than Periodic should be paid within 30 days after receipt is due. The payor is required to notify the insured, their assignee or health care professional/facility if due proof of loss has not been received within the 30 days of the claim being received. 

                If payments are not made within the time frame, the law entitles the health care professional/facility to interest at the rate of 9% per year from the date the payment was required, to the date of the late payment. The interest is required to be paid within 30 days after the payment, unless it is less than $1. In the case of payments that are not periodic, the interest rate is 9% per year from the 30th day after the receipt is due. Interest payments must be made within the 30 days after the late payment, unless less than $1.

                The Department of Insurance will enforce these laws, and has complaint processes in place for those who do not comply.