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

Under N.J.A.C. 11:22-1.5(e); N.J.S.A. 17:48C-8.1, 17:48D-9.4; 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. 11:22-1.5(e), first sentence). Dental applicability: Expressly covered, with a dental-specific interest rate. 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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Dentovio

Dental expressly covered · Last verified 2026-08-31

New Jersey prompt-pay law for dental claims

New Jersey's prompt-pay law covers dental claims. Clean claims must be paid or denied within 30 calendar days electronic, 40 calendar days paper; late payment accrues statutory interest.

N.J.A.C. 11:22-1.5(e); N.J.S.A. 17:48C-8.1, 17:48D-9.4; 17B:30-26 to -34

Read the statute text

Payment deadlines

Electronic claims: 30 calendar days (clean claims)
Paper claims: 40 calendar days (clean claims)

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.

Interest and penalties

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), first sentence). Health carriers — insurance companies, service corporations, HMOs — owe 12% per year under the same rule's second sentence and N.J.S.A. 17B:27-44.2(d)(9). Entity type, not plan type, picks the rate: a dental plan written by an insurance company, health service corporation, or medical service corporation is a dental carrier that is also a health carrier, so it pays 12%. Read the entity type off the plan document before quoting a figure — "10%" to an insurer-written dental line and "12%" to a dental service corporation are both wrong. Interest starts at day 30/40 from receipt of all information required to process the claim.

Does it apply to dental? Dental expressly covered

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 chapter's "dental carrier" also covers health service corporations, medical service corporations, and insurance companies writing dental plans; the chapter's "health benefits plan" definition expressly excludes dental plans, so dental sits in its own defined lane rather than riding the medical rules. The statute reaches insured plans only (N.J.S.A. 17B:30-27).

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 New Jersey rule (N.J.A.C. 11:22-1.5(e); N.J.S.A. 17:48C-8.1, 17:48D-9.4; 17B:30-26 to -34). Estimate only — the statute's own accrual triggers control.

How the claim was submitted

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

Electronic— 30 calendar days (clean claims)Paper— 40 calendar days (clean claims)

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 (30 calendar days (clean claims)), not days since submission.

Estimated interest

$10.48

10% per year (simple)

10%/yr applies only to dental plan organizations and dental service corporations (N.J.A.C. 11:22-1.5(e), first sentence). A dental plan written by an insurance company, health service corporation, or medical service corporation is a "dental carrier" that is also a "health carrier," and its late clean claims carry 12%/yr under the second sentence. Check which entity type is on the plan document before quoting a rate. A dental-only insurer not authorized to write health benefits plans is in neither category and 1.5(e) names no rate for it.

How we calculate this

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(e); N.J.S.A. 17:48C-8.1, 17:48D-9.4; 17B:30-26 to -34, 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

Capitation payments have their own rule: overdue if not remitted by the 5th business day after the due date, bearing 10% simple interest (N.J.S.A. 17B:30-32).
The dental appeal tracks are in-network only: N.J.A.C. 11:22-1.11 and 1.12 run to "participating health care providers," and the external ADR decision is non-binding unless both sides agree. A non-par dentist gets the payment deadline and the interest, not the appeal route — and dental never reaches HCAPPA's arbitration at 11:22-1.13.
The statutory hook is the member's claim: N.J.S.A. 17:48C-8.1(e) defines an insured claim as "a claim by a subscriber," extended to "that subscriber's agent or assignee if the contract provides for assignment of benefits." The regulation is broader, but do not assume a non-assigned dentist has independent standing.
Neither the dental statutes nor N.J.A.C. 11:22-1.5 contains an anti-waiver clause. Unlike Florida, New Jersey is silent on whether a network agreement can alter these terms — say silent, not "cannot be waived."

Sources (statute text)