# Tennessee prompt-pay law for dental claims

> What is the Tennessee prompt-pay deadline for dental claims, and what interest applies to late payment? Read against the statute text (Tenn. Code Ann. §56-7-109).

URL: https://dentovio.com/dental-prompt-pay-laws/tennessee

Last verified: 2026-08-30

Dentovio is an independent publisher, not a law firm, insurance department, or government agency. This page was drafted with AI assistance and read against the primary sources linked here, with a per-claim verification record — quote, statutory pinpoint, and the URL actually opened — behind every deadline, rate, and applicability verdict in all fifty-one jurisdictions. It has not been reviewed by a credentialed attorney or dental billing specialist. These pages summarize state prompt-pay statutes as read against the official sources on the date shown, focusing on how each statute treats dental claims. Statutes change and their application turns on plan type, contract status, and claim facts. Educational reference only — not legal advice; confirm current law with the state insurance department or a licensed attorney before acting on a specific claim.

## Direct answer

Under Tenn. Code Ann. §56-7-109, the Tennessee payment deadline is 30 calendar days (clean claims). The statute is described by the Department of Commerce and Insurance as carrying interest penalties and remediation requirements, and a related section (§56-7-1023(e)) refers to "the interest penalties and remediation requirements" under §56-7-109 — but the operative subsection could not be read on an official host, so this page states no rate. Dental applicability: The Attorney General quotes the definition: a "health insurance entity" is an entity subject to Tennessee insurance law or the commissioner's jurisdiction that contracts or offers to contract to provide health insurance coverage, "including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation" — an illustrative, not exclusive, list. 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.

## Payment deadlines

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

Tennessee's prompt-pay requirements under §56-7-109 require, in the Department of Commerce and Insurance's words, "that clean claims be paid no later than 30 calendar days after the date that an issuer receives a claim from a provider" (TDCI Bulletin, "Prompt Pay Provisions and the ACA Grace Period," April 2014). A shorter deadline for electronically submitted claims is widely reported for Tennessee, but the statutory subsection sits behind a CAPTCHA gate on the state's designated code host and could not be read on an official source — so this page publishes only the 30-day requirement and no shorter electronic figure. A clean claim is one "that requires no further information, adjustment or alteration by the provider of the services in order to be processed and paid by the health insurer," with no defect, impropriety, missing substantiating documentation, or circumstance requiring special treatment; duplicates are excluded.

## Interest and penalties on late payment

The statute is described by the Department of Commerce and Insurance as carrying interest penalties and remediation requirements, and a related section (§56-7-1023(e)) refers to "the interest penalties and remediation requirements" under §56-7-109 — but the operative subsection could not be read on an official host, so this page states no rate. Everything else here comes from official Tennessee documents: the TDCI bulletin of April 2014 and Attorney General Opinion 09-157 (2009). Both are official but dated; they evidence the statutory language they quote, not the statute's 2026 currency, which was confirmed separately on the state's code host.

## Does it apply to dental? Dental scope unsettled

The Attorney General quotes the definition: a "health insurance entity" is an entity subject to Tennessee insurance law or the commissioner's jurisdiction that contracts or offers to contract to provide health insurance coverage, "including, but not limited to, an insurance company, a health maintenance organization and a nonprofit hospital and medical service corporation" — an illustrative, not exclusive, list. The same opinion quotes the exclusions from "health insurance coverage": accident, credit, disability income, long-term care, hospital indemnity, Medicare supplement, specified disease, "other limited benefit health insurance," and automobile medical payment coverage. Dental is not named in that list, but whether a stand-alone dental policy is other limited benefit health insurance is settled by no authority read here. Two firmer limits: self-insured ERISA plans are not health insurance entities, and TennCare runs on a different regime entirely.

## 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.

## Also in the statute

- TennCare claims are a separate regime: TDCI measures TennCare managed care organizations, pharmacy benefit managers, and dental benefit managers under Tenn. Code Ann. §56-32-126(b)(1) — 90% of claims processed and paid within 30 days and 99.5% within 60 days. A practice billing a TennCare dental benefit manager should not be quoted the commercial deadline.
- TDCI treats claims pended for enrollees in months two and three of the ACA premium grace period as a circumstance requiring special treatment rather than a violation.
- No 2024 or 2025 amendment to §56-7-109 was found; the 2024 public chapter sometimes cited amended a different section.
- The state's designated code host requires accepting terms of use and clears automated access through a CAPTCHA — the statutory text is public, but a person has to open it.

## Sources (statute text)

- [Tenn. Code Ann. §56-7-109 — Tennessee Code Unannotated, the state's designated free public access host (terms gate)](https://advance.lexis.com/container?config=014CJAA5ZGVhZjA3NS02MmMzLTRlZWQtOGJjNC00YzQ1MmZlNzc2YWYKAFBvZENhdGFsb2e9zYpNUjTRaIWVfyrur9ud&crid=tennessee-code)
- [TDCI Bulletin — prompt pay provisions and the ACA grace period (April 2014)](https://www.tn.gov/content/dam/tn/commerce/documents/insurance/bulletins/042914.pdf)
- [Tennessee Attorney General Opinion 09-157 (2009) — health insurance entity and coverage definitions](https://www.tn.gov/content/dam/tn/attorneygeneral/documents/ops/2009/op09-157.pdf)
- [TDCI TennCare Oversight — prompt pay compliance reports (dental benefit managers)](https://www.tn.gov/commerce/tenncare-oversight/reports/prompt-pay-compliance-reports.html)

## Related

- [All state prompt-pay pages](https://dentovio.com/dental-prompt-pay-laws/index.html.md)
- [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md)
- [Payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md)