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

Dental covered, with caveats · Last verified 2026-08-30

Virginia prompt-pay law for dental claims

Virginia's prompt-pay law reaches dental claims with caveats. Clean claims must be paid or denied within 40 days; what late payment costs is set out below.

Va. Code §38.2-3407.15

Read the statute text

Payment deadlines

Electronic claims: 40 days (contracted providers, no format split)
Paper claims: 40 days (contracted providers, no format split)

A carrier must pay any claim within 40 days of receipt, except where its obligation to pay is not reasonably clear on a reasonable basis supported by specific information available for review by the person who submitted the claim, or where there is a fraud basis. The carrier must notify the submitter of any defect or impropriety within 30 days of receipt — and if it misses that notice, the claim is treated as clean regardless of the defect. From January 1, 2026 those notices must be delivered electronically. This is a provider-contract fair-business standard: "claim" means a claim made to a carrier with which the provider has a provider contract, and capitation and withhold payments are excluded.

Interest and penalties

The payment rule is about timing and demand, not rate: "Any interest owing or accruing on a claim under §38.2-3407.1 or 38.2-4306.1, under any provider contract or under any other applicable law, shall, if not sooner paid or required to be paid, be paid, without necessity of demand, at the time the claim is paid or within 60 days thereafter" (subdivision B 3). Remedies are unusually strong: a provider may recover actual damages, treble damages for gross negligence or willful conduct, and attorney fees (subsection G), and a carrier is not in violation where the submitter materially caused the failure or compliance was impossible.

Does it apply to dental? Dental covered, with caveats

Dental is inside the subject matter: "health care services" means items or services furnished to any individual for the purpose of preventing, alleviating, curing, or healing human illness, injury or physical disability, and "carrier" reaches any person required to be licensed under the title that operates a managed care health insurance plan or provides or arranges health care services, plans, networks, or provider panels regulated as the business of insurance. Two limits matter. The 40-day rule is a provider-contract standard, so it reaches contracted providers rather than every out-of-network claim. And the stand-alone-dental carve-out that exists in this section is narrow — subdivision B 5 b's downcoding protections do not apply to limited-scope benefits including stand-alone dental plans, while the payment deadline, notice rule, and interest rule carry no dental carve-out.

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 Virginia rule (Va. Code §38.2-3407.15). 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 (40 days (contracted providers, no format split)), not days since submission.

No published rate to apply

Section 38.2-3407.15 sets no rate of its own. It requires that any interest owing or accruing under §38.2-3407.1, §38.2-4306.1, the provider contract, or any other applicable law be paid without necessity of demand, at the time the claim is paid or within 60 days after — so the rate comes from whichever of those sources applies to the claim.

How we calculate this

The calculator does not show a payable amount for this result; the explanation above states the controlling limitation. The rate and deadline come from Va. Code §38.2-3407.15, 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

"Health plan" excludes Medicare, Medicaid, CHIP, FEHB, and TRICARE coverage, plus accident-only, credit, disability, long-term care, Medicare supplement, and workers' compensation.
An amended version of §38.2-3407.15 takes effect January 1, 2027 — re-check the text before relying on this page after that date.
The current version has been amended through the 2026 Acts of Assembly (cc. 881, 1055).

Sources (statute text)

Va. Code §38.2-3407.15 — Virginia Law Portal (version effective until January 1, 2027)