# Texas prompt-pay law for dental claims

> What is the Texas prompt-pay deadline for dental claims, and what interest applies to late payment? Verified against the statute text (Tex. Ins. Code §1301.002; §843.338; §843.342; Ch. 542 Subch. B).

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

Last verified: 2026-08-29

Dentovio is an independent publisher, not a law firm, insurance department, or government agency. These pages summarize state prompt-pay statutes as verified against the legislature's published text on the last-verified date, 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 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.

## 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 on late payment

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.

## 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).

## Sources (statute text)

- [Tex. Ins. Code Ch. 1301 (incl. §1301.002 dental exclusion)](https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1301.htm)
- [Tex. Ins. Code Ch. 843 (HMO clean-claim deadlines and penalties)](https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm)
- [Tex. Ins. Code Ch. 542 (general prompt payment)](https://statutes.capitol.texas.gov/Docs/IN/htm/IN.542.htm)
- [Texas Department of Insurance — SB 418 prompt-pay FAQ](https://www.tdi.texas.gov/hprovider/ppsb418faq.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)