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

Dental expressly covered · Last verified 2026-08-29

North Carolina prompt-pay law for dental claims

N.C. Gen. Stat. §58-3-225

Under N.C. Gen. Stat. §58-3-225, the North Carolina payment deadline is 30 days for clean/complete claims. Late payments bear interest at 18% per year beginning the day after the claim should have been paid (§58-3-225(e)). Dental applicability: Covered — and the reasoning matters. Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.

Read the statute text

Payment deadlines

Electronic claims: 30 calendar days (all claims)
Paper claims: 30 calendar days (all claims)

Within 30 calendar days of receipt, the insurer must pay, deny, or send one of four enumerated notices (inadequate proof of loss, wrong form, COB information needed, or pending on unpaid fees/premiums). There is no electronic-vs-paper deadline split — the formats differ only in when receipt is presumed (transmission day for electronic; mailing plus five business days for paper). After requested information arrives, a fresh 30-day clock runs; if the information never arrives, the insurer must deny at 90 days with a one-year reopening right.

Interest and penalties

Late payments bear interest at 18% per year beginning the day after the claim should have been paid (§58-3-225(e)). The interest attaches automatically; insurers paying it in good faith are shielded from separate Commissioner sanctions for that claim.

Does it apply to dental? Dental expressly covered

Covered — and the reasoning matters. North Carolina's default "health benefit plan" definition elsewhere excludes limited-scope dental, but §58-3-225 carries its own definition whose exclusion list omits dental and vision, and the default yields to a section-specific definition (§58-3-167(b)). Standalone dental insurers, Article 65 dental service corporations, and dental HMOs writing dental coverage are therefore inside the prompt-pay statute. Plans administered by NC or U.S. DHHS (Medicaid dental) are outside it.

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.

Estimate the late-payment interest

Uses the verified North Carolina rule (N.C. Gen. Stat. §58-3-225). 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 (30 calendar days (all claims)), not days since submission.

Estimated interest

$18.86

18% per year (simple)

Self-executing from the day after payment was due.

How we calculate this

Formula: claim × 18% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from N.C. Gen. Stat. §58-3-225, 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.

Also in the statute

Insurers may not set claim-filing deadlines shorter than 180 days from the date of care (§58-3-225(f)).
Overpayment recoupment requires 30 days' written notice and must occur within two years of the original payment absent fraud; providers get a mirror two-year window for underpayments plus interest (§58-3-225(h)).

Payment deadlines

Interest and penalties

Does it apply to dental? Dental expressly covered

Estimate the late-payment interest

Also in the statute

Sources (statute text)