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

Split regime for dental · Last verified 2026-08-29

Texas prompt-pay law for dental claims

Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B

Under Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B, the Texas payment deadline is 30 days (dental HMO clean claims, §843.338) and 45 days (dental HMO clean claims, §843.338). Dental HMO clean claims: §843.342's tiered penalties — the lesser of 50% of the billed-minus-contracted difference or $100,000 (paid late but before day 46 after the required adjudication date), the lesser of 100% or $200,000 (day 46–90), and beyond day 90 the tier-two penalty plus 18% annual interest on the penalty amount. Dental applicability: Split regime. Self-funded (ERISA) plans are outside this statute — federal ERISA deadlines apply to them instead.

Read the statute text

Payment deadlines

Electronic claims: 30 days (dental HMO clean claims, §843.338)
Paper claims: 45 days (dental HMO clean claims, §843.338)

Texas's famous clean-claim regime does not apply to dental insurance: §1301.002 says Chapter 1301 "does not apply to a provision for dental care benefits in a health insurance policy." The 30-day electronic / 45-day paper clean-claim deadlines reach dental only through dental HMOs under §843.338, because Chapter 843 defines an HMO to include single-service plans and its clean-claim subchapter has no dental carve-out. Dental insurers (PPO/indemnity dental) fall under the general prompt-payment act instead: acknowledge within 15 days, accept or reject within 15 business days after receiving all requested items, and pay within 5 business days of acceptance (§§542.055–.057).

Interest and penalties

Dental HMO clean claims: §843.342's tiered penalties — the lesser of 50% of the billed-minus-contracted difference or $100,000 (paid late but before day 46 after the required adjudication date), the lesser of 100% or $200,000 (day 46–90), and beyond day 90 the tier-two penalty plus 18% annual interest on the penalty amount. Dental insurers under Ch. 542: 18% per year on the claim as damages, plus reasonable attorney's fees (§542.060) — with the caveat that Subchapter B defines "claim" as a first-party claim, so a practice's ability to collect depends on assignment/beneficiary status.

Does it apply to dental? Split regime for dental

Split regime. Dental benefits in insurance policies are expressly excluded from the SB 418 clean-claim chapter (§1301.002) — the tiered penalties most billing articles quote never apply to dental PPO or indemnity plans. Dental HMOs are covered by the parallel Chapter 843 clean-claim rules. Dental insurers answer to the older Chapter 542 prompt-payment act (15-business-day accept/reject, 18%/yr damages plus attorney's fees), which the Texas Department of Insurance confirms does not reach self-funded ERISA plans, government plans, Medicaid, or Medicare Advantage.

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 Texas rule (Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B). 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 days (dental HMO clean claims, §843.338)), not days since submission.

No single formula applies

Two different regimes apply depending on the entity — see the detail on this page before estimating anything.

How we calculate this

This state's regime has entity-dependent rules, so the page explains them instead of computing a single number. The rate and deadline come from Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B, 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

Providers face their own deadline: a claim must be submitted within 95 days after the date of service or the right to payment is forfeited (§1301.102).
The clean-claim deadlines run for contracted (preferred/participating) providers; out-of-network reach is limited to emergency care and insurer-requested services (§1301.069, §843.351).

Payment deadlines

Interest and penalties

Does it apply to dental? Split regime for dental

Estimate the late-payment interest

Also in the statute

Sources (statute text)