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

Under Md. Code Ann., Ins. §15-1005, the Maryland payment deadline is 30 days (pay or send a receipt-and-status notice). Maryland puts the rate in the statute, not in regulation: interest runs on the amount unpaid 30 days after receipt at the monthly rate of 1.5 percent from the 31st through the 60th day, 2 percent from the 61st through the 120th day, and 2.5 percent after the 120th day (§15-1005(g)(1)). Dental applicability: Covered by cross-reference rather than by name. 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 covered, with caveats · Last verified 2026-08-30

Maryland prompt-pay law for dental claims

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

Md. Code Ann., Ins. §15-1005

Read the statute text

Payment deadlines

Electronic claims: 30 days (pay or send a receipt-and-status notice)
Paper claims: 30 days (pay or send a receipt-and-status notice)

Within 30 days after receiving a claim for reimbursement, an insurer, nonprofit health service plan, or health maintenance organization must either mail or transmit payment or send a notice of receipt and status of the claim. Undisputed portions must still be paid within 30 days when part of a claim is contested, and after requested additional information arrives the payer gets a fresh 30 days. "Clean claim" itself is defined by Commissioner regulation under §15-1003 (COMAR 31.10.11), not in the statute.

Interest and penalties

Maryland puts the rate in the statute, not in regulation: interest runs on the amount unpaid 30 days after receipt at the monthly rate of 1.5 percent from the 31st through the 60th day, 2 percent from the 61st through the 120th day, and 2.5 percent after the 120th day (§15-1005(g)(1)). It "shall be included in any late reimbursement without the necessity for the person that filed the original claim to make an additional claim for that interest." Administrative penalties are separate: up to $500 for each violation that is arbitrary and capricious, plus §4-113(d) penalties where the conduct is frequent enough to be a general business practice.

Does it apply to dental? Dental covered, with caveats

Covered by cross-reference rather than by name. Section 15-1005(c) governs claims "from a person entitled to reimbursement under §15-701(a)," and §15-701(a) reaches any service within the lawful scope of practice of a health care provider licensed under the Health Occupations Article — dentists are Health Occupations Article licensees. The statute is provider-neutral and never says "dental." One correction worth carrying: Medicaid managed care organizations are nowhere in §15-1005, so do not use this section for an MCO claim.

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 Maryland rule (Md. Code Ann., Ins. §15-1005). 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 (pay or send a receipt-and-status notice)), not days since submission.

Estimated interest

$21.25

1.5%/mo then 2%/mo (monthly tiers, prorated by days)

Monthly rates set by the statute itself: 1.5% from the 31st through the 60th day, 2% from the 61st through the 120th, and 2.5% after the 120th — included in the late reimbursement without an additional claim for it.

How we calculate this

Formula: claim × monthly tier rate × days in tier ÷ 30, summed across tiers, using simple (not compounded) interest as the statute states it. The rate and deadline come from Md. Code Ann., Ins. §15-1005, 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

Carriers must allow a provider at least 180 days from the date of service to submit a claim and at least 90 working days after a denial to appeal it (§15-1005(e)).
A provider that notifies the carrier of a claims-processing error within one year of the denial forces reprocessing without resubmission and without regard to timely-filing deadlines (§15-1005(e)(3)).
Credit-card and virtual-card payment fees require advance notice, a no-fee alternative, and the provider's election (§15-1005(d)).
Provider prompt-pay complaints go to the Maryland Insurance Administration through its online complaint portal; the MIA asks for a representative sample of no more than ten claims against one carrier.
The official statute viewer carries no amendment history, so no last-amendment date is stated here.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental covered, with caveats

Estimate the late-payment interest

Also in the statute

Sources (statute text)