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

Under C.R.S. §10-16-106.5, the Colorado payment deadline is 30 calendar days (electronic) and 45 calendar days (any other means). A carrier that misses the deadline owes the insured or the health care provider, with proper assignment, interest at 10 percent annually on the total amount ultimately allowed, accruing from the date payment was due (§10-16-106.5(5)(a)). Dental applicability: The statutory text points toward dental claims being inside the scheme. 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 covered, with caveats · Last verified 2026-08-30

Colorado prompt-pay law for dental claims

Colorado's prompt-pay law reaches dental claims with caveats. Clean claims must be paid or denied within 30 calendar days electronic, 45 calendar days paper; late payment accrues statutory interest.

C.R.S. §10-16-106.5

Read the statute text

Payment deadlines

Electronic claims: 30 calendar days (electronic)
Paper claims: 45 calendar days (any other means)

Clean claims must be paid, denied, or settled within 30 calendar days of receipt when submitted electronically and 45 calendar days when submitted by any other means. Everything else has a 90-day outer limit: the carrier must request missing information within 30 days, the provider then has 30 days to supply it, and the claim may be denied for non-response subject to resubmission or appeal. Receipt is defined, not assumed — an electronic claim is presumed received on the date of the carrier's electronic verification, and for claims filed any other way the carrier must run a tracking mechanism that lists the claim within ten business days, with the listing date as the receipt date.

Interest and penalties

A carrier that misses the deadline owes the insured or the health care provider, with proper assignment, interest at 10 percent annually on the total amount ultimately allowed, accruing from the date payment was due (§10-16-106.5(5)(a)). Quoting only that rate understates Colorado: a carrier that has not paid, denied, or settled within ninety days of receiving the claim owes an additional penalty equal to 20 percent of the amount ultimately allowed, imposed on the ninety-first day (§10-16-106.5(5)(b)). Penalties not paid with the claim may be batched quarterly or once a provider's aggregate exceeds ten dollars.

Does it apply to dental? Dental covered, with caveats

The statutory text points toward dental claims being inside the scheme. Section 10-16-106.5 attaches to any "carrier" and defines a clean claim through the uniform-claim-forms statute, which expressly includes "the claim form adopted by the American dental association for use by all dental providers and carriers in the state" (§10-16-106.3(1)). The stand-alone-dental exclusion that circulates for Colorado belongs to the essential-health-benefits section (§10-16-103.4(6)) and applies to that section only; the prompt-pay statute never uses the "health benefit plan" term that carries the dental carve-out. The hedge: no Division of Insurance bulletin or case law was checked on this point, so treat it as a strong textual reading rather than a settled ruling.

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 Colorado rule (C.R.S. §10-16-106.5). Estimate only — the statute's own accrual triggers control.

How the claim was submitted

Colorado sets a different deadline for each, so this decides which day the field below counts from.

Electronic— 30 calendar days (electronic)Paper— 45 calendar days (any other means)

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

Estimated interest

$10.48

10% per year (simple)

10% annually on the total amount ultimately allowed, accruing from the date payment was due. Colorado adds a separate 20% penalty on the ninety-first day — this estimate does not include it. Penalties may be paid quarterly or once a provider's aggregate exceeds $10.

How we calculate this

Formula: claim × 10% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from C.R.S. §10-16-106.5, 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 20% penalty on the ninety-first day is the bigger stick — any Colorado summary quoting only 10% interest understates the exposure (§10-16-106.5(5)(b)).
Interest and penalties run to the insured or to the provider "with proper assignment" — direct recovery by the practice depends on the assignment.
Workers' compensation claims and claims for services after the first month of a three-month grace period are outside the section (§10-16-106.5(8)).
Enforcement is the Division of Insurance (DORA); separately, C.R.S. §10-3-1116(1) lets a first-party claimant sue for two times the covered benefit plus fees and costs on an unreasonably delayed or denied claim.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental covered, with caveats

Estimate the late-payment interest

Also in the statute

Sources (statute text)