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

Dental expressly covered · Last verified 2026-08-30

Ohio prompt-pay law for dental claims

Ohio's prompt-pay law covers dental claims. Clean claims must be paid or denied within 30 days; late payment accrues statutory interest.

Ohio Rev. Code §3901.381; §3901.389; §3901.38

Read the statute text

Payment deadlines

Electronic claims: 30 days (standard claim form, no format split)
Paper claims: 30 days (standard claim form, no format split)

When a third-party payer receives a claim on the standard claim form prescribed by the superintendent's rules under §3902.22, it must pay or deny the claim not later than thirty days after receipt (§3901.381(B)(1)). Where the payer determines that reasonable supporting documentation is needed the window is forty-five days, and the clock is tolled while the requested documentation is outstanding; a materially deficient claim gets a fifteen-day notice. Provider contracts can restructure payment timing entirely under §3901.383 — capitation and periodic payment arrangements included.

Interest and penalties

"Any third-party payer that fails to comply with section 3901.381 … shall pay interest," and "the interest rate … shall be equal to an annual percentage rate of eighteen per cent" (§3901.389(A)–(B)). Subsection (D) requires that interest be paid directly to the provider at the time the claim is paid and forbids using it to reduce benefits or payments otherwise payable. Complaints go to the superintendent under §3901.3810 — there is no percentage-of-claims threshold to clear first — and enforcement escalates through compliance reports, market-conduct exams, and pattern-or-practice fines under §§3901.3811–.3812.

Does it apply to dental? Dental expressly covered

Covered, in the statute's own words. "Benefits contract" means a sickness and accident insurance policy providing hospital, surgical, or medical expense coverage, or a health insuring corporation contract or other policy under which a third-party payer agrees to reimburse for covered health care "or dental services," and the provider definition lists a dentist by name (§3901.38(B), (D)). The claim-processing section even requires use of the most current CDT code published by the American Dental Association. Two things this does not reach: Medicaid is expressly excluded (§3901.3814(D)), along with Medicare Advantage, TRICARE, and preempted ERISA self-insured plans — Medicaid claims run on the federal timeframes in 42 C.F.R. 447.46 instead.

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 Ohio rule (Ohio Rev. Code §3901.381; §3901.389; §3901.38). 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 (30 days (standard claim form, no format split)), not days since submission.

Estimated interest

$18.86

18% per year (simple)

A flat statutory 18% annual rate, paid directly to the provider at the time the claim is paid, and it may not be used to reduce benefits or payments otherwise payable.

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 Ohio Rev. Code §3901.381; §3901.389; §3901.38, 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

There is no "20% of a payer's monthly claims" complaint trigger in Ohio law — a provider or beneficiary may simply file a written complaint with the superintendent (§3901.3810(A)).
Even for an exempt Medicaid payer, a provider contract may not set payment periods longer than 42 C.F.R. 447.46 allows (§3901.383(B)).
The overpayment-recoupment section in the same chapter (§3901.388) has a new version taking effect October 7, 2026.

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)