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

Under 215 ILCS 5/368a(c); 215 ILCS 5/370a, the Illinois payment deadline is 30 days (no format split). Failure to pay within the 30-day period entitles the payee to interest at 9 percent per year "from the 30th day after receipt of such proof of loss to the date of late payment," with amounts under one dollar excused; any required interest payment must itself be made within 30 days after the payment (§368a(c)). Dental applicability: Covered, through the assignment statute. 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.

Dental expressly covered · Last verified 2026-08-30

Illinois prompt-pay law for dental claims

Illinois's prompt-pay law covers dental claims. Clean claims must be paid or denied within 30 days; late payment accrues statutory interest.

215 ILCS 5/368a(c); 215 ILCS 5/370a

Read the statute text

Payment deadlines

Electronic claims: 30 days (no format split)
Paper claims: 30 days (no format split)

Insurers, health maintenance organizations, managed care plans, health care plans, preferred provider organizations, and third-party administrators must pay all claims for health care services — other than periodic payments — within 30 days after receipt of due written proof of loss (§368a(c)). Independent practice associations and physician-hospital organizations are covered separately by §368a(b) on the same 30-day clock. "Clean claim" is not an Illinois term here: the trigger is "due written proof of loss," and the payor must give notice of any known failure to provide sufficient documentation within 30 days after receiving the claim.

Interest and penalties

Failure to pay within the 30-day period entitles the payee to interest at 9 percent per year "from the 30th day after receipt of such proof of loss to the date of late payment," with amounts under one dollar excused; any required interest payment must itself be made within 30 days after the payment (§368a(c)). Late periodic payments carry the same 9 percent from the date payment was required (§368a(a)(1)). The Department of Insurance enforces the section and has specific authority to issue cease-and-desist orders, fines, or other penalties against independent practice associations and physician-hospital organizations that violate it.

Does it apply to dental? Dental expressly covered

Covered, through the assignment statute. Section 370a directs that when an enrollee or insured of an insurer, HMO, managed care plan, health care plan, preferred provider organization, dental service plan corporation, dental insurer, or third-party administrator assigns a claim to a health care professional, facility, dental care provider, or dental care facility, payment must be made directly to that provider — "including any interest required under Section 368a of this Code for failure to pay claims within 30 days after receipt by the insurer of due proof of loss." That dental-care-provider language is fresh law, amended effective January 1, 2026, so pre-2026 quotations of §370a are stale.

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 Illinois rule (215 ILCS 5/368a(c); 215 ILCS 5/370a). 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 days (no format split)), not days since submission.

Estimated interest

$9.43

9% per year (simple)

Interest runs from the 30th day after receipt of due proof of loss — not day 31. Interest amounting to less than one dollar need not be paid, and any required interest payment must be made within 30 days after the claim payment.

How we calculate this

Formula: claim × 9% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from 215 ILCS 5/368a(c); 215 ILCS 5/370a, 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

Recoupments and offsets may not be requested or withheld from future payments 12 months or more after the original payment, subject to exceptions for fraud findings, Medicaid requirements, or mutual agreement (215 ILCS 5/368d).
The statute is silent on network status — it says "all claims" without a network qualifier.
Section 368a was last amended in 2012 (P.A. 97-813); §370a took effect in its current form on January 1, 2026, and §368d was amended effective August 15, 2025.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental expressly covered

Estimate the late-payment interest

Also in the statute

Sources (statute text)