# Colorado prompt-pay law for dental claims

> What is the Colorado prompt-pay deadline for dental claims, and what interest applies to late payment? Read against the statute text (C.R.S. §10-16-106.5).

URL: https://dentovio.com/dental-prompt-pay-laws/colorado

Last verified: 2026-08-30

Dentovio is an independent publisher, not a law firm, insurance department, or government agency. This page was drafted with AI assistance and read against the primary sources linked here, with a per-claim verification record — quote, statutory pinpoint, and the URL actually opened — behind every deadline, rate, and applicability verdict in all fifty-one jurisdictions. It has not been reviewed by a credentialed attorney or dental billing specialist. These pages summarize state prompt-pay statutes as read against the official sources on the date shown, focusing on how each statute treats dental claims. Statutes change and their application turns on plan type, contract status, and claim facts. Educational reference only — not legal advice; confirm current law with the state insurance department or a licensed attorney before acting on a specific claim.

## Direct answer

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.

## 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 on late payment

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.

## 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.

## Sources (statute text)

- [C.R.S. §10-16-106.5 — Colorado Revised Statutes 2024, Title 10 (official OLLS PDF, pp. 761–764)](https://content.leg.colorado.gov/sites/default/files/images/olls/crs2024-title-10.pdf)
- [Colorado Division of Insurance (DORA)](https://doi.colorado.gov/)

## Related

- [All state prompt-pay pages](https://dentovio.com/dental-prompt-pay-laws/index.html.md)
- [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md)
- [Payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md)