Dental expressly covered · Last verified 2026-08-29
O.C.G.A. §33-24-59.5; §33-24-59.14
Under O.C.G.A. §33-24-59.5; §33-24-59.14, the Georgia payment deadline is 15 working days (electronic) and 30 calendar days (paper). Late payments owe interest at 12% per year (§33-24-59.5(c); §33-24-59.14(c)) — mandatory and owed to the claimant. Dental applicability: Expressly covered: Georgia's definition of "health benefit plan" includes "any dental or vision care plan or policy" (§33-24-59.5(a)(2), incorporated by §33-24-59.14). Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.
Insurers and administrators must pay or send a denial/deficiency notice within 15 working days for electronic claims or 30 calendar days for paper claims — §33-24-59.14 for claims payable to the provider, §33-24-59.5 for claims payable to the member. When requested documentation arrives, a fresh identical period runs. Undisputed portions must be paid on time.
Late payments owe interest at 12% per year (§33-24-59.5(c); §33-24-59.14(c)) — mandatory and owed to the claimant. Many billing references still quote 18% and a flat 15-working-day deadline; that was the 1999 version of the law, replaced in 2011. The Commissioner can add administrative penalties only for systemic non-compliance (processing under 95% of claims on time in a quarter).
Expressly covered: Georgia's definition of "health benefit plan" includes "any dental or vision care plan or policy" (§33-24-59.5(a)(2), incorporated by §33-24-59.14). The provider-claims section's limited-benefit exclusion names accident-only, CHAMPUS supplement, disability income, fixed indemnity, long-term care, and specified disease — dental is not on the list. Both sections apply only to fully insured business and TPA business; the Eleventh Circuit held the 2011 amendments preempted as applied to self-funded ERISA plans (AHIP v. Hudgens).
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.
Uses the verified Georgia rule (O.C.G.A. §33-24-59.5; §33-24-59.14). Estimate only — the statute's own accrual triggers control.
Estimated interest
$12.58
12% per year (simple)
The 18% figure that circulates online is the pre-2011 statute — repealed by HB 167 (2011).
Formula: claim × 12% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from O.C.G.A. §33-24-59.5; §33-24-59.14, 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.
