If a claim is not denied within 90 days, it can only be denied later based on what?

If a claim is not denied within 90 days, it can only be denied later based on what?

• A. Deny
• B. Accept
• C. Delay and investigate
• D. Close the file

Answer: (A)

The rule being tested is that claim decisions must be made within 90 days. If no denial or payment decision is issued in that period, the claim is deemed denied by operation of law. Because of that, any later disposition on the claim must be a denial. Accepting the claim, delaying the decision, or simply closing the file would contradict the deemed-denied status, whereas a denial aligns with the automatic consequence of not denying in time.

The rule being tested is that claim decisions must be made within 90 days. If no denial or payment decision is issued in that period, the claim is deemed denied by operation of law. Because of that, any later disposition on the claim must be a denial. Accepting the claim, delaying the decision, or simply closing the file would contradict the deemed-denied status, whereas a denial aligns with the automatic consequence of not denying in time.