Dental expressly covered · Last verified 2026-08-29
N.J.A.C. 11:22-1.5; N.J.S.A. 17B:30-26 to -34
Under N.J.A.C. 11:22-1.5; N.J.S.A. 17B:30-26 to -34, the New Jersey payment deadline is 30 calendar days (clean claims) and 40 calendar days (clean claims). Late clean claims from dental plan organizations and dental service corporations accrue simple interest at 10% per year, added to the claim payment automatically (N.J.A.C. Dental applicability: Expressly covered, with a dental-specific interest rate. Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.
Clean claims must be paid within 30 calendar days when submitted electronically (or the federal Medicare time limit, whichever is earlier) and 40 calendar days on paper. The rule applies expressly to dental service corporations and dental plan organizations — N.J.A.C. 11:22-1.1(b) names them, and the enabling statute (N.J.S.A. 17B:30-26) defines "carrier" to include both.
Late clean claims from dental plan organizations and dental service corporations accrue simple interest at 10% per year, added to the claim payment automatically (N.J.A.C. 11:22-1.5(e)). Health carriers — insurance companies, service corporations, HMOs — owe 12% per year under the same rule and N.J.S.A. 17B:27-44.2(d)(9). Interest starts at day 30/40 from receipt of all information required to process the claim.
Expressly covered, with a dental-specific interest rate. New Jersey is unusual in naming dental entities directly: the prompt-pay subchapter applies to any dental service corporation or dental plan organization issuing dental plans in the state, and dental entities have their own internal and external appeal tracks (N.J.A.C. 11:22-1.11 and 1.12). The statute reaches insured plans only (N.J.S.A. 17B:30-27).
Self-funded (ERISA) plans: Self-funded employer (ERISA) dental plans are outside every state prompt-pay statute — federal law preempts state insurance regulation of self-funded plans. Those claims run on the federal ERISA claims-procedure deadlines 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.
Uses the verified New Jersey rule (N.J.A.C. 11:22-1.5; N.J.S.A. 17B:30-26 to -34). Estimate only — the statute's own accrual triggers control.
Estimated interest
$10.48
10% per year (simple)
10%/yr for dental plan organizations and dental service corporations; health carriers owe 12%/yr. An insurer-issued standalone dental policy may fall under the 12% sentence — the regulation names only DPOs/DSCs at 10%.
Formula: claim × 10% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from N.J.A.C. 11:22-1.5; N.J.S.A. 17B:30-26 to -34, verified against the statute text linked in the sources on this page (last verified 2026-08-29). 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.
