What is the California prompt-pay deadline for dental claims, and what interest applies to late payment?

Under Cal. Health & Safety Code §1371.35; Cal. Ins. Code §10123.13, the California payment deadline is 30 calendar days (complete claims). A late complete claim carries interest at 15 percent per annum beginning the first calendar day after the 30-day period, plus the greater of an additional $15 or a fee of 10 percent of the accrued interest. Dental applicability: Covered, expressly. A self-funded private-employer (ERISA) plan is generally beyond this statute's reach and runs on the federal claims-procedure clock instead — but that comes from the courts reading 29 U.S.C. § 1144, not from its text, and it is not categorical: a self-funded governmental or church plan is not an ERISA plan at all, § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law, and nothing in § 1144 bars a state from reaching the third-party administrator or the network contract.

Dental expressly covered · Last verified 2026-08-30

California prompt-pay law for dental claims

California's prompt-pay law covers dental claims. Clean claims must be paid or denied within 30 calendar days; late payment accrues statutory interest.

Cal. Health & Safety Code §1371.35; Cal. Ins. Code §10123.13

Read the statute text

Payment deadlines

Electronic claims: 30 calendar days (complete claims)
Paper claims: 30 calendar days (complete claims)

Both California regimes now run on the same clock. A health care service plan — including a specialized plan — must reimburse a complete claim, in state or out of state, as soon as practicable and no later than 30 calendar days after receipt (§1371.35(a)); health insurers owe the same 30 calendar days under Ins. Code §10123.13. The transition from working days is finished: the current text is operative as of January 1, 2026, so summaries still describing 30 working days or a 45-day HMO clock are describing repealed law. The same 30-day clock governs a notice contesting or denying the claim. The section does not apply to capitated payments, claims involving fraud or misrepresentation, eligibility determinations, or claims where the plan was denied reasonable access to information.

Interest and penalties

A late complete claim carries interest at 15 percent per annum beginning the first calendar day after the 30-day period, plus the greater of an additional $15 or a fee of 10 percent of the accrued interest. Both statutes require the payer to include all accrued interest in the payment automatically, without a request from the claimant. The insurer side reached 15 percent through AB 487 (Stats. 2025, ch. 558), so any table still showing 10 percent for California insurers is out of date.

Does it apply to dental? Dental expressly covered

Covered, expressly. Section 1371.35(a) binds "a health care service plan, including a specialized health care service plan," and a specialized health care service plan contract is defined as a contract for health care services in a single specialized area of health care, "including dental care" (Health & Safety Code §1345). California dental plans regulated by the Department of Managed Health Care are therefore squarely inside the 30-day clock and the 15 percent interest. Dental coverage written as insurance instead falls under Ins. Code §10123.13. Capitated payments are outside the section either way — relevant to dental HMO arrangements.

Self-funded (ERISA) plans: A self-funded private-employer (ERISA) dental plan is generally beyond a state prompt-pay statute's reach: 29 U.S.C. § 1144(b)(2)(B) bars a state from deeming such a plan an insurer, and the courts have read that to keep state insurance regulation off it. The statute itself never uses the words self-funded or prompt pay, and the rule is not categorical — a self-funded governmental or church plan is not an ERISA plan at all, so state law can reach it; § 1144(b)(6) leaves multiple employer welfare arrangements open to state insurance law; and nothing in § 1144 addresses state enforcement against the third-party administrator or the network contract. Where the plan is a self-funded ERISA group health plan, the federal claims-procedure deadlines apply instead: a post-service benefit determination within 30 days (one 15-day extension), at least 180 days to appeal, and an appeal decision within 60 days (or two 30-day levels), under 29 CFR 2560.503-1.

Estimate the late-payment interest

Uses the verified California rule (Cal. Health & Safety Code §1371.35; Cal. Ins. Code §10123.13). Estimate only — the statute's own accrual triggers control.

Claim amount (allowed)Interest statutes run on the payable claim amount, not billed charges.Days past the deadlineDays after the statutory deadline for this claim (30 calendar days (complete claims)), not days since submission.

Estimated interest

$15.72

15% per year (simple)

Plus the greater of $15 or 10% of the accrued interest, which the plan or insurer must include in the payment without the claimant asking. Insurers moved from 10% to 15% effective January 1, 2026 — an older 10% figure is stale.

How we calculate this

Formula: claim × 15% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from Cal. Health & Safety Code §1371.35; Cal. Ins. Code §10123.13, read against the statute text linked in the sources on this page (last verified 2026-08-30). Accrual start dates, clean-claim status, safe harbors, and plan funding all affect the real figure — treat this as an estimate for the payer conversation, not a demandable amount.

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Also in the statute

The current text was repealed and re-added by AB 3275 (Stats. 2024, ch. 763) effective January 1, 2025 and operative January 1, 2026; Ins. Code §10123.13 was then amended by AB 487 (Stats. 2025, ch. 558).
Capitated payments are expressly outside §1371.35.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental expressly covered

Estimate the late-payment interest

Also in the statute

Sources (statute text)