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Texas prompt pay law dental

Under Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B, the Texas payment deadline is 30 days (dental HMO clean claims, §843.338) and 45 days (dental HMO clean claims, §843.338). Dental HMO clean claims: §843.342's tiered penalties — the lesser of 50% of the billed-minus-contracted difference or $100,000 (paid late but before day 46 after the required adjudication date), the lesser of 100% or $200,000 (day 46–90), and beyond day 90 the tier-two penalty plus 18% annual interest on the penalty amount. Dental applicability: Split regime. Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.

Last verified
2026-08-29
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Source citations

  • PROMPTPAY-TEXAS-1 Tex. Ins. Code Ch. 1301 (incl. §1301.002 dental exclusion) (statutes.capitol.texas.gov)
  • PROMPTPAY-TEXAS-2 Tex. Ins. Code Ch. 843 (HMO clean-claim deadlines and penalties) (statutes.capitol.texas.gov)
  • PROMPTPAY-TEXAS-3 Tex. Ins. Code Ch. 542 (general prompt payment) (statutes.capitol.texas.gov)

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