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

Split regime for dental · Last verified 2026-08-29

Florida prompt-pay law for dental claims

Fla. Stat. §627.6131; §641.3155; §627.613; Ch. 636

Under Fla. Stat. §627.6131; §641.3155; §627.613; Ch. 636, the Florida payment deadline is 20 days to pay, deny, or contest (electronic) and 40 days to pay, deny, or contest (paper). Overdue payments bear simple interest at 12% per year, beginning when the claim should have been paid, denied, or contested, and the interest must be paid with the claim (§627.6131(7); identical for HMOs at §641.3155(6)). Dental applicability: Three lanes. Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.

Read the statute text

Payment deadlines

Electronic claims: 20 days to pay, deny, or contest (electronic)
Paper claims: 40 days to pay, deny, or contest (paper)

Provider claims to health insurers run under §627.6131 — not the older §627.613 that most summaries quote (that section covers claims from the insured, at 45 days and 10%). Electronic claims must be acknowledged within 24 hours after the start of the next business day and paid, denied, or contested within 20 days; paper claims acknowledged within 15 days and resolved within 40. Hard backstops: an electronic claim must be paid or denied within 90 days, and failure to do so within 120 days creates an uncontestable obligation to pay (120/140 days for paper).

Interest and penalties

Overdue payments bear simple interest at 12% per year, beginning when the claim should have been paid, denied, or contested, and the interest must be paid with the claim (§627.6131(7); identical for HMOs at §641.3155(6)). The section cannot be waived by contract.

Does it apply to dental? Split regime for dental

Three lanes. (1) Dental-only insurance written by a licensed insurer is expressly inside §627.6131 — subsection (15) applies the section to "a group or individual insurance contract that only provides direct payments to dentists for enumerated dental services." (2) Comprehensive HMOs with dental benefits answer to the mirror rule at §641.3155. (3) Prepaid dental plans licensed under Chapter 636 (prepaid limited health service organizations) have no statutory prompt-pay deadline and no interest rule at all — Chapter 636 exempts them from the Insurance Code unless specifically referenced, and no prompt-pay statute references them.

Self-funded (ERISA) plans: Self-funded employer (ERISA) dental plans are outside every state prompt-pay statute — federal law preempts state insurance regulation of self-funded plans. Those claims run on the federal ERISA claims-procedure deadlines 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 Florida rule (Fla. Stat. §627.6131; §641.3155; §627.613; Ch. 636). 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 (20 days to pay, deny, or contest (electronic)), not days since submission.

Estimated interest

$12.58

12% per year (simple)

Simple interest, accruing from when the claim should have been paid, denied, or contested; payable with the claim.

How we calculate this

Formula: claim × 12% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from Fla. Stat. §627.6131; §641.3155; §627.613; Ch. 636, verified against the statute text linked in the sources on this page (last verified 2026-08-29). 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.

Also in the statute

For contracts issued or renewed on or after January 1, 2025, §627.6131(20)–(21) adds dental-specific protections: an insurer cannot make credit-card payment the only payment method, EFT/virtual-card fees require notice and consent, and claims for procedures specifically included in a prior authorization cannot be denied except in enumerated circumstances (parallel prior-auth rule for prepaid plans at §636.035(15)).
Provider claims must reach the primary insurer within 6 months of service; insurer clawbacks against dentists are limited to 12 months after payment (§627.6131(18)).

Payment deadlines

Interest and penalties

Does it apply to dental? Split regime for dental

Estimate the late-payment interest

Also in the statute

Sources (statute text)