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

Under KRS 304.17A-702; 304.17A-730; 304.17C-090, the Kentucky payment deadline is 30 calendar days (all clean claims). KRS 304.17A-730 sets one retroactive rate by how late the claim is ultimately paid: 12% per year if paid 1–30 days late, 18% if 31–60 days late, and 21% beyond 60 days — the top tier triggers at day 61, not day 90 as often misquoted. Dental applicability: Expressly covered by a dedicated bridge 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.

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Dental expressly covered · Last verified 2026-08-31

Kentucky prompt-pay law for dental claims

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

KRS 304.17A-702; 304.17A-730; 304.17C-090

Read the statute text

Payment deadlines

Electronic claims: 30 calendar days (all clean claims)
Paper claims: 30 calendar days (all clean claims)

Insurers must pay, deny, or contest a clean claim within 30 calendar days of receipt (60 days for organ-transplant claims). The payment deadline is format-neutral; only acknowledgment differs — 48 hours for electronic claims, 20 days for paper. For dental-only plans, KRS 304.17C-090 applies the prompt-pay statutes with one relaxation: 3 business days, rather than 48 hours, to respond to electronically submitted claims. That subsection also gives dental-only plans an alternative method of compliance the general rule does not allow — instead of transmitting an acknowledgment, the plan "may list the claim and the date it was received on a file that can be accessed electronically by the provider, its agent, or designee." A practice checking whether its dental payer complied must check the payer's electronic claim-status file, not just its inbox.

Interest and penalties

KRS 304.17A-730 sets one retroactive rate by how late the claim is ultimately paid: 12% per year if paid 1–30 days late, 18% if 31–60 days late, and 21% beyond 60 days — the top tier triggers at day 61, not day 90 as often misquoted. The insurer must add the interest without the provider asking. Separate department fines run up to $1,000 per day or 10% of the unpaid claim, whichever is greater, but only where the insurer misses KRS 304.99-123(2)'s quarterly compliance thresholds — 95% of clean claims adjudicated on time (pharmaceutical excluded) and at least 90% of the total dollar amount of non-denied, non-contested clean claims paid on time. A separate fine of up to $10,000 applies to a willful and knowing violation or a pattern of repeated violations (KRS 304.99-123(1)(b)). The rates themselves need no annual re-check: Kentucky hard-codes 12/18/21% in the statute and has not amended §§304.17A-702 or -730 since 2002.

Does it apply to dental? Dental expressly covered

Expressly covered by a dedicated bridge statute. Kentucky's general definitions exclude dental-only policies from "health benefit plan" — a trap for anyone reading only KRS 304.17A-005 — but KRS 304.17C-090 independently applies the prompt-pay statutes to limited health service benefit plans providing dental-only benefits, with three modifications (3-business-day electronic response, annual reporting, and the $5 interest floor). The clean-claim definition even specifies the ADA-approved form for dentists.

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 Kentucky rule (KRS 304.17A-702; 304.17A-730; 304.17C-090). 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 (all clean claims)), not days since submission.

Estimated interest

$18.86

18% per year (rate set by final lateness, applied retroactively from the due date)

A single rate chosen by final lateness, accruing retroactively from the due date. For dental-only plans, interest is owed only when it reaches at least $5 on the claim.

How we calculate this

Formula: claim × tier rate × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from KRS 304.17A-702; 304.17A-730; 304.17C-090, 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

Interest is excused when the failure is due to events beyond the insurer's control (acts of God, epidemics, strikes, war, facility disruptions). The statutory list is expressly "including but not limited to," and the trigger reaches a failure caused by outside events "in whole or in part" — so the interest is not automatic.
Fines extend to Medicaid managed care organizations (KRS 304.99-123(3)) — even though KRS Chapter 205 coverage is excluded from the "health benefit plan" definition. Both halves of that split are real; publish neither alone.
The ERISA carve-out is on the face of the definition here, and it cuts narrower than most states: KRS 304.17A-005(29) names a self-insurer "including a governmental plan, church plan, or multiple employer welfare arrangement, not exempt from state regulation by ERISA" as an insurer, so self-funded governmental and church plans are inside. A blanket "government plans are excluded" line is wrong in Kentucky.
A payer contract can set the amount but never the clock: KRS 304.17A-702(2)(a) pays "in accordance with any contract between the insurer and the provider," while KRS 304.17A-726 bars an insurer from requiring a provider "to pursue any other course of action regarding the payment of health care claims outside of the provisions set forth in KRS 304.17A-700 to 304.17A-730."

Sources (statute text)