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

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Split regime for dental · Last verified 2026-08-31

Florida prompt-pay law for dental claims

Florida runs more than one prompt-pay regime for dental claims. Which deadline and interest rate apply depends on the payer type, set out below.

Fla. Stat. §627.6131; §641.3155; §627.613; §636.003(5), §636.004, §636.029(1), §636.035(15)

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 an insured or an insured's assignees — a dentist holding an assignment of benefits is an assignee — at 45 days and 10%, with 60 days to pay or deny after requested additional information arrives and a 120-day outer limit, §627.613(2)–(4)). 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) A dental plan is expressly inside §627.6131 where it pays the dentist directly — subsection (15) applies the section to "a group or individual insurance contract that only provides direct payments to dentists for enumerated dental services." Read that limb as written: a dental plan that reimburses the member rather than paying the dentist arguably sits outside it, and this record does not state the outer edge of §627.6131, because the "major medical expense" definition subsection (15) cross-references is a rulemaking category label rather than a definition (§627.643(2)(e)) and its content sits in Commission rule. (2) Comprehensive HMOs with dental benefits answer to the mirror rule at §641.3155 — §641.19(4) names dental care among comprehensive health care services, and §641.19(12) means a dental-only entity cannot be an HMO. (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 — §636.004 and §636.029(1) exempt them from the Insurance Code unless specifically referenced, and neither §627.6131 nor §641.3155 mentions them. That is the lane a great many Florida dental practices actually bill, so never publish "Florida = 20/40 days, 12%" flat.

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 Florida rule (Fla. Stat. §627.6131; §641.3155; §627.613; §636.003(5), §636.004, §636.029(1), §636.035(15)). Estimate only — the statute's own accrual triggers control.

How the claim was submitted

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

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

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 (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; §636.003(5), §636.004, §636.029(1), §636.035(15), read against the statute text linked in the sources on this page (last verified 2026-08-31). 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

For contracts delivered, 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 acceptable method; EFT or virtual-card use requires notice and signed consent that applies to the dentist's entire practice and may not be demanded patient-by-patient; no ACH transmission fee without the dentist's consent (§627.6131(20)(c)); and claims for procedures specifically included in a prior authorization cannot be denied except in five enumerated circumstances. "Delivered" is the limb that catches an out-of-state-issued contract delivered in Florida. The same prior-authorization protection, same effective date, applies to prepaid dental plans at §636.035(15) — so Chapter 636 plans did gain that, even though they gained no prompt-pay clock and no interest.
Provider claims must reach the primary insurer within 6 months after both the date of service (or inpatient discharge) and the date the provider was furnished the correct name and address of the patient's health insurer — i.e. from the later of the two (§627.6131(3)(b)) — and a secondary insurer within 90 days after the primary's final determination; insurer clawbacks against dentists are limited to 12 months after payment (§627.6131(18)), except from providers convicted of fraud under §817.234, with the mirror 12-month window for a provider's underpayment claim at (19) carrying no such exception.
The section may not be waived, voided, or nullified by contract (§627.6131(10); §641.3155(9)), and the deadline is not conditioned on network participation — §627.6131(9) reaches a provider "regardless of whether the provider is under contract with the health insurer." Enforcement runs through the Office of Insurance Regulation; nothing in the section creates an express private right of action for the dentist.

Sources (statute text)