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

Under Mo. Rev. Stat. §376.383; §376.384; §376.427, the Missouri payment deadline is 45 processing days (electronic claims only); No prompt-pay protection (paper claims are outside §376.383). If the carrier has not paid by the forty-fifth processing day, it owes "one percent interest per month and a penalty in an amount equal to one percent of the claim per day," calculated on the unpaid balance as of that day; on claims where the amount owed exceeds thirty-five thousand dollars the 1 percent per day penalty is capped at 100 days and 2 percent per month runs afterward (§376.383.6(1)). Dental applicability: Dental payers are inside, but by a route worth knowing. 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

Missouri prompt-pay law for dental claims

Missouri's prompt-pay law reaches dental claims with caveats. The payment deadline and the interest it carries are below.

Mo. Rev. Stat. §376.383; §376.384; §376.427

Read the statute text

Payment deadlines

Electronic claims: 45 processing days (electronic claims only)
Paper claims: No prompt-pay protection (paper claims are outside §376.383)

Missouri's prompt-pay law reaches electronic claims only: "Any claim submitted by a health care provider after January 1, 2003, in a nonelectronic format shall not be subject to the provisions of section 376.383" (§376.384.2). For electronic claims the trigger is 45 "processing days," and processing days exclude any day the carrier is waiting for a response to a request for additional information. The operative workflow deadlines are shorter: 48 hours to acknowledge an electronic claim, 30 processing days to pay or deny a clean claim or request information, 10 processing days after receiving additional information, and 5 processing days after a final-request response.

Interest and penalties

If the carrier has not paid by the forty-fifth processing day, it owes "one percent interest per month and a penalty in an amount equal to one percent of the claim per day," calculated on the unpaid balance as of that day; on claims where the amount owed exceeds thirty-five thousand dollars the 1 percent per day penalty is capped at 100 days and 2 percent per month runs afterward (§376.383.6(1)). A carrier may combine interest payments and pay once the aggregate reaches one hundred dollars. Figures still circulating from the 2002–2011 version of this statute — a 50 percent penalty capped at $20 a day triggered 40 days after notice, and a $5 aggregation floor — were repealed across two rewrites and are not current law. Claims properly denied before day 45 owe nothing, and where a denial is appealed and then approved, accrual runs from the date the first appeal was filed.

Does it apply to dental? Dental covered, with caveats

Dental payers are inside, but by a route worth knowing. Section 376.427 defines "health carrier" for its own purposes to include "a prepaid dental plan corporation, as defined in section 354.700," and §376.427.6 provides that payments made to providers under that section are subject to §376.383, with a delayed effective date of January 1, 2026 for entities not already subject — a date that has now passed. Dental indemnity insurers were arguably already inside §376.1350's broad health carrier definition. The bigger practical caveat is format: a paper dental claim gets no prompt-pay protection in Missouri at all.

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 Missouri rule (Mo. Rev. Stat. §376.383; §376.384; §376.427). Estimate only — the statute's own accrual triggers control.

How the claim was submitted

Missouri sets a different deadline for each, so this decides which day the field below counts from.

Electronic— 45 processing days (electronic claims only)Paper— No prompt-pay protection (paper claims are outside §376.383)

Claim amount (allowed)Interest statutes run on the payable claim amount, not billed charges.Days past the deadlineDays after the statutory deadline for a electronic claim (45 processing days (electronic claims only)), not days since submission.

No single formula applies

Missouri stacks interest and a per-day penalty, so a single rate would misstate it. On a claim unpaid by the forty-fifth processing day the carrier owes 1% interest per month plus a penalty of 1% of the claim per day. Where the unpaid balance exceeds $35,000, the 1%/day penalty runs for a maximum of 100 days and 2% per month applies thereafter. Payments may be combined until the aggregate reaches $100.

How we calculate this

The calculator does not show a payable amount for this result; the explanation above states the controlling limitation. The rate and deadline come from Mo. Rev. Stat. §376.383; §376.384; §376.427, 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

Out-of-network providers get one year to file; in-network providers get six months unless the contract specifies a different standard, and carrier refunds or offsets are capped at 12 months absent fraud (§376.384.1).
Enforcement is the Department of Commerce and Insurance: administrative penalties up to $25 per claim with a $250,000 annual aggregate, plus orders to remit interest with a penalty up to 25% of the unpaid interest (§376.384.3–.4).
Courts must award reasonable attorney fees where a carrier withheld payment without good cause — and award the carrier fees against a groundless provider suit (§376.383.6(2)).
The dental hook runs through §376.427 (assignment of benefits and direct payment), not through a freestanding amendment to §376.383.

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)