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

Under Mass. Gen. Laws c. 176I §2; c. 176G §6; c. 175 §108(4)(c); c. 175 §110(G); c. 176A §8(e); c. 176B §7, the Massachusetts payment deadline is 45 days (from receipt of completed forms). Each of the six statutes carries the same interest term: 1.5 percent per month, not to exceed 18 percent per year, accruing beginning 45 days after the organization's receipt of the request for reimbursement. Dental applicability: Not established for dental carriers. 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 scope unsettled · Last verified 2026-08-30

Massachusetts prompt-pay law for dental claims

Massachusetts's prompt-pay statute never names dental, and its definitions do not settle whether it reaches a stand-alone dental carrier. The deadlines are below.

Mass. Gen. Laws c. 176I §2; c. 176G §6; c. 175 §108(4)(c); c. 175 §110(G); c. 176A §8(e); c. 176B §7

Read the statute text

Payment deadlines

Electronic claims: 45 days (from receipt of completed forms)
Paper claims: 45 days (from receipt of completed forms)

Massachusetts has no single prompt-pay chapter. The 45-day duty appears in six parallel statutes by payer type: preferred provider arrangements (c. 176I §2), HMOs (c. 176G §6), individual accident and sickness policies (c. 175 §108(4)(c)), group and blanket policies (c. 175 §110(G) — §110 expressly notes the non-applicability of §108), nonprofit hospital service corporations (c. 176A §8(e)), and medical service corporations (c. 176B §7). Within 45 days of receiving completed forms, the organization must pay, notify the provider in writing of the reasons for nonpayment, or notify the provider what additional information is needed. Under the c. 175 sections the 45 days runs from receipt of notice of claim rather than completed forms. Chapter 176O, often cited for this, contains no payment deadline or interest provision at all.

Interest and penalties

Each of the six statutes carries the same interest term: 1.5 percent per month, not to exceed 18 percent per year, accruing beginning 45 days after the organization's receipt of the request for reimbursement. A claim the organization is investigating because of suspected fraud is exempt from the interest provisions — that is an interest exemption, not a suspension of the payment deadline, and should not be described as pausing the clock.

Does it apply to dental? Dental scope unsettled

Not established for dental carriers. The widely repeated line that chapter 176O "applies to health, dental and vision care providers" does not survive reading: 176O reaches dental carriers only in the sections that expressly say "including a dental or vision carrier" — advocacy, indemnification, incentive plans, evidence of coverage, credentialing-denial notice, interpreter services — and none of those is a payment-deadline provision. Chapter 176O §1 also walls dental off from the general "carrier" definition. Prompt-pay protection therefore has to come from the insurer-type statutes: a dental insurer writing accident and sickness policies under chapter 175 falls under §§108(4)(c) and 110(G), while whether a dental service corporation sits inside chapter 176B was not established by the sources read here.

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.

Because this statute never names dental, whether it reaches your claim is unresolved. Treat anything below as the figure the statute would produce if it applies — read the applicability note above first.

Estimate the late-payment interest

Uses the verified Massachusetts rule (Mass. Gen. Laws c. 176I §2; c. 176G §6; c. 175 §108(4)(c); c. 175 §110(G); c. 176A §8(e); c. 176B §7). 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 (45 days (from receipt of completed forms)), not days since submission.

Estimated interest

$19.13

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

1.5% per month, capped by statute at 18% per year. Note the mismatch the statutes build in: the payment window runs from receipt of completed forms, while interest accrues from receipt of the request for reimbursement.

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 Mass. Gen. Laws c. 176I §2; c. 176G §6; c. 175 §108(4)(c); c. 175 §110(G); c. 176A §8(e); c. 176B §7, 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

Chapter 176O §2(h) preserves carriers' obligations under chapters 175, 176A, 176B, 176G, and 176I — the hook that ties the managed-care chapter to the payment statutes.
The in-network / out-of-network question is not answered by these texts: the 176G and 176B duties sit in participating-provider sections, and the c. 175 sections speak of "claimant or provider" with no network language.
Enforcement of chapter 176O §§2–12 is the Insurance Commissioner's; the Office of Patient Protection sits in the Health Policy Commission and handles insured grievances and external review, not provider prompt pay.
The official statute pages carry no amendment history, so no last-amendment date is stated here.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental scope unsettled

Estimate the late-payment interest

Also in the statute

Sources (statute text)