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AB 52

Revises provisions relating to the payment of claims under policies of health insurance. (BDR 57-367)

2025 Regular Session

AB 52 standardizes health claim payments to 21 days (electronic) or 30 days (non-electronic), with prompt denials, annual reporting, and enforcement to ensure faster, transparent p

Approved by the Governor. Chapter 366.
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Bill Summary · AB 52

AB 52 — Summary (Revises payment of claims under health insurance policies)

Chapter 366 — Approved by the Governor (June 6, 2025)

Purpose / Intent

AB 52 standardizes and shortens timelines for processing and paying health insurance claims, increases transparency for providers and insureds, requires annual reporting to the Commissioner of Insurance, and creates administrative enforcement tools to address slow or unreasonable claim handling. It also directs the Division of Insurance to run outreach and education for providers and consumers about claims and dispute-resolution rights.

Key provisions

  • Prompt-pay timelines (uniform for administrators and most private health insurers):
    • Approve or deny a claim and, if approved, pay within:
    • 21 days after receipt if the claim is submitted electronically; or
    • 30 days after receipt if the claim is not submitted electronically.
    • If additional information is needed, the insurer/administrator must request it within 20 working days after receiving the claim.
    • After receipt of requested additional information, pay approved claims within 21 days (electronic) or 30 days (non-electronic).
  • Denials: an insurer/administrator may not deny a claim without a reasonable basis; denials must be communicated within the statutory timelines and include specified information (reasons, policy provisions relied on, etc.).
  • Notices and provider information:
    • Health carriers must provide participating providers and covered persons at least annually with an explanation of how remittances/payments are made.
    • Network health carriers must establish an efficient process by which a participating provider can challenge a denial of a claim.
  • Reporting and outreach:
    • Insurers/administrators must report annually to the Commissioner of Insurance on compliance with the prompt-pay requirements.
    • The Division of Insurance must establish and carry out outreach/education campaigns to inform providers and insureds about claim payment laws and dispute resolution; resources for small or new providers must be developed.
  • Enforcement and penalties:
    • The Commissioner may impose administrative penalties for noncompliance and may suspend or revoke registration/authority for repeated violations.
    • Additional penalty authority applies when an entity fails to approve/deny or pay a claim within 60 working days after receipt.

Who is affected

  • Primary: administrators of health insurance plans and private health insurers operating in the state (including managed care organizations, issuers of dental plans, and fraternal benefit societies where specified).
  • Providers of health care (participating network providers) and insureds — benefit from faster payments, required notices, and appeal processes.
  • The Division of Insurance — tasked with outreach, report collection, and enforcement (with some fiscal implications).
  • Some state programs (Medicaid, CHIP, and the Public Employees’ Benefits Program) are treated differently in the bill text; several amendments and committee actions addressed exemptions and scope during the legislative process.

Procedural / timeline notes

  • Bill progressed through multiple committee amendments and reprints (including changes to timelines, scope, and exemptions).
  • Final enrolled bill was delivered to the Governor June 4, 2025 and approved June 6, 2025 (Chapter 366).
  • The bill assigns new duties to the Division of Insurance (outreach and reporting oversight); the Division provided a fiscal note noting that outreach requirements may have cost implications depending on scope.

Note: The bill underwent significant amendment (timelines adjusted from earlier drafts, scope exclusions for certain public programs refined). For implementation details and any agency rules, consult the enrolled chapter text (Chapter 366, 2025) and subsequent guidance from the Division of Insurance.

Compiled from official sources — confirm details with the bill’s official record.

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