Every state sets its own deadlines for how fast health plans must pay claims, decide prior authorizations, and finish credentialing, and every Medicaid program sets its own filing limit. A practice that works in more than one state needs those numbers in one place. This page compares the six states where we see the most questions, with a full guide for each.
The rules below apply to state-regulated commercial plans. Self-funded employer plans follow federal law instead. Since January 2026, the federal interoperability rule also requires Medicaid managed care and Medicare Advantage plans to decide standard prior authorizations within 7 calendar days and expedited ones within 72 hours.
The rules side by side
| State | Claim payment (commercial) | Prior authorization (commercial) | Credentialing | Medicaid filing limit |
|---|---|---|---|---|
| Washington | 95% of clean claims in 30 days; 95% of all claims in 60 | 3 days electronic, 5 otherwise; expedited 1 or 2 days | 90 days; retroactive pay; CAQH only | Varies by Apple Health plan (Molina: 180 days) |
| Arizona | Adjudicate in 30 days, pay 30 days later; 10% interest | Urgent 5 days, non-urgent 14 | 60 days since April 2026; retroactive pay | AHCCCS fee-for-service: 6 months (some plans 120 days) |
| California | 30 working days (HMOs 45); 15% or 10% interest | 5 business days; urgent 72 hours | No general state deadline found | Medi-Cal: 6 months, reduced pay to 12 |
| Oregon | 30 days; 12% interest from day 31 | 2 business days | No statutory deadline found for commercial plans | OHP fee-for-service: 12 months |
| Massachusetts | 45 days; 1.5% a month interest | New rules proposed in 2026 (211 CMR 52) | No statutory deadline found | MassHealth: 90 days; final 12 months |
| Rhode Island | 30 days electronic, 40 paper; 12% interest | Varies; BCBSRI dropped it for outpatient behavioral health | 45 days (10 business days if Medicare-credentialed); provisional if missed | Medicaid fee-for-service: 12 months |
Sources for each number are in the state guides. "No deadline found" means we didn't find a state statute setting one; individual plans and contracts still set their own.
What the six states have in common
- The complete-application date decides credentialing. In Washington, Arizona, and Rhode Island, the deadline and any retroactive payment run from when the application was complete. Save that confirmation.
- Prompt pay only protects clean claims filed on time. Rhode Island's protection ends at 90 days after service. Everywhere, a rejected claim was never received.
- Medicaid limits vary within a state. Arizona's own fee-for-service limit is 6 months, but one of its plans requires 120 days. Use the shortest limit you bill against as your internal deadline.
- Electronic is faster. Washington gives electronic prior authorizations a 3-day deadline instead of 5, and Rhode Island gives electronic claims 30 days instead of 40.
Our own standard for the practice side
State law tells payers what they owe you. It doesn't tell a practice how fast to verify eligibility, submit claims, or work denials. We wrote that standard ourselves: the SNG Practice Standards, 24 measurable targets that work in any state.
When to bring in help
Sharp Networks Group handles billing and credentialing for therapy, behavioral health, and speech therapy practices across these states and others. If you're expanding to a new state, read our multi-state billing article, or schedule a consultation.
Last reviewed October 2026. Laws and plan policies change. Confirm current rules with each state's insurance regulator, Medicaid agency, and each plan. You're welcome to link to this page as a reference.