Every payer's administrative requirements — timely filing limits, prompt-pay statutes, appeal deadlines — in one searchable, dated, sourced reference.
What it is
Contract Term Library is the reference companion to PayerPolicy Watch's change feed: where PayerPolicy Watch tells you what just changed, Contract Term Library tells you what the rule currently is. For every commercial payer and every state, the library captures timely filing limits, prompt-pay statutory deadlines, appeal turnaround requirements, prior-authorization decision windows, fee schedule update cadence, and the administrative requirements that govern claims submission and reconsideration.
Each entry is sourced to the carrier provider manual or the state statute that establishes it, with the publication or enactment date. When the rule changes, the prior version is preserved in the history view — a litigator can pull the term that was in force on the date of service, not just the current version.
Adjacent extension of PayerPolicy Watch, same pipeline. Sold under named institutional license to RCM operations and provider-side counsel.
Sample: major commercial payers
Illustrative excerpt. Live product carries all commercial payers, state Medicaid programs, and Medicare Advantage plans, with source links and version history on every term.
| Payer | Timely filing Initial claim |
Timely filing Corrected / rebill |
First-level appeal Provider deadline |
Prompt-pay window Electronic claims |
PA decision window Standard / urgent |
|---|---|---|---|---|---|
| Aetna | 365 days from DOS | 365 days from remit date | 180 days from denial date | 30 days (commercial) | 15 days / 72 hrs |
| Anthem / Elevance | 90–180 days varies by state contract |
60 days from remit date | 120 days from denial date | 30 days | 15 days / 72 hrs |
| Blue Cross Blue Shield National accounts |
180 days from DOS varies by plan |
180 days from remit date varies by plan |
180 days from denial date | 30–45 days | 14 days / 72 hrs |
| Cigna | 90 days from DOS 120 days if payer error |
60 days from remit date | 90 days from denial date | 30 days | 14 days / 72 hrs |
| Humana | 365 days from DOS | 365 days from DOS | 60 days from denial date | 30 days | 14 days / 72 hrs |
| UnitedHealthcare | 90–365 days varies by product |
365 days from remit date | 60–180 days varies by product |
30 days | 15 days / 72 hrs |
Sample: prompt-pay statutory deadlines by state
State statute governs where the commercial contract is silent or the subscriber's employer is fully-insured. Self-insured (ERISA) plans are governed by the plan document, not state statute.
| State | Electronic clean claim | Paper clean claim | Disputed claim decision | Interest rate (late payment) |
|---|---|---|---|---|
| California | 30 days | 45 days | 45 days | 15% per annum |
| Florida | 20 days | 35 days | 120 days | 12% per annum |
| Illinois | 30 days | 45 days | 60 days | 9% per annum |
| New York | 30 days (EDI) 45 days (paper) | 45 days | 45 days | 12% per annum |
| Texas | 30 days | 45 days | Not specified | 18% per annum |
| Pennsylvania | 45 days | 45 days | 45 days | 10% per annum |
History view: every term carries a version trail
When a payer changes a term, the prior version is preserved. A litigator or auditor can pull the rule that was in force on any past date of service.
Primary data sources
- Carrier provider manuals — Administrative requirements, timely filing limits, appeal deadlines
- State prompt-pay statutes — Statutory payment-timing requirements by state
- CMS Conditions of Participation — Federal baseline requirements
- State insurance code — State-level administrative requirements on health insurers
Buyers
- Hospital and physician-group revenue cycle leadership
- Provider-side healthcare attorneys
- Managed-care contracting teams
- RCM software companies licensing reference data
Methodology
Every term is sourced to the provider manual or statute that establishes it. Prior versions are preserved with effective dates so a litigator can pull the term that was in force on any past date. Source links point to the specific section of the document that establishes the rule — not the document root. Update cadence follows manual publication schedules; the last-verified date is visible on every term.
Inquire about access
Contract Term Library is sold under named institutional license. Pricing is scoped per engagement. Reach out with the institutional context — organization, role, intended use — and we’ll route a relevant scope of work.