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

Dental covered, with caveats · Last verified 2026-08-30

Delaware prompt-pay law for dental claims

Delaware's prompt-pay law reaches dental claims with caveats. Clean claims must be paid or denied within 30 calendar days; what late payment costs is set out below.

18 Del. Admin. Code 1310 §6.0; 18 Del. C. §3370C

Read the statute text

Payment deadlines

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

Delaware's deadline lives in a regulation, not the statute. Within 30 calendar days of receiving a clean claim, a carrier must do one of four things: pay the total allowed amount, pay the undisputed portion, notify the provider or policyholder in writing why the claim will not be paid, or request documentation in writing. After an information request, the carrier has 15 days from receiving the requested information to act, and it may make only one clinical-information request per claim plus one further request solely for coordination-of-benefits or duplicate checking. The statute contributes the filing floor instead: regardless of network status, a carrier must allow a provider at least 180 days from the date of service to submit a claim.

Interest and penalties

Regulation 1310 §8.0 gives the Insurance Commissioner power to order a carrier "found to have violated Section 6" to pay the claim plus interest at the maximum rate allowable to lenders under Delaware law, computed from the date payment was first required. That is a remedy the Commissioner may order, not interest that accrues on its own from day 31, and the lender maximum under 6 Del. C. §2301(a) is 5 percent over the Federal Reserve discount rate including any surcharge — a floating figure, and not the "prime plus 5" that circulates. Three failures to comply within any 36-month period create a rebuttable presumption of an unfair practice under 18 Del. C. §2304, and the regulation creates no private cause of action.

Does it apply to dental? Dental covered, with caveats

Dental is neither named nor exempted, so coverage rests on the breadth of the carrier definition: "any entity that provides health insurance in this State," including health insurance companies, health service corporations, health maintenance organizations, "and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation," plus third-party administrators that adjust, administer, or settle claims. The exemption list — accident-only, credit, Medicaid, Medicare supplement, long-term care, disability income, liability supplement, workers' compensation, and auto medical payments — does not mention dental. Read the rule as reaching a state-regulated dental carrier, while noting the statute never says so in terms.

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 Delaware rule (18 Del. Admin. Code 1310 §6.0; 18 Del. C. §3370C). 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 (uniform)), not days since submission.

Interest only if a court or regulator orders it

Delaware interest is a discretionary remedy, not an automatic accrual, so this page will not produce a figure. The Commissioner may order a carrier found to have violated the processing rule to pay the claim plus interest at the maximum rate allowable to lenders under Delaware law — 5% over the Federal Reserve discount rate including any surcharge (6 Del. C. §2301(a)) — computed from the date the claim was first required to be paid.

How we calculate this

The calculator does not show a payable amount for this result; the explanation above states the controlling limitation. The rate and deadline come from 18 Del. Admin. Code 1310 §6.0; 18 Del. C. §3370C, 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 provider definition covers participating and non-participating providers alike, and §3370C(b) applies its 180-day filing floor "regardless of network status."
Prescribed clean-claim formats are CMS 1500 or UB-92 (or successors) on paper and ASC X12N 837 electronically; a duplicate is never a clean claim.
The regulation is non-waivable by contract (§9.0) and creates no private cause of action — enforcement runs through the Commissioner only (§10.0).
The current uniform 30-day text has been effective for claims submitted on or after November 1, 2005.

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)