# Washington prompt-pay law for dental claims

> What is the Washington prompt-pay deadline for dental claims, and what interest applies to late payment? Read against the statute text (WAC 284-170-431 (formerly WAC 284-43-321)).

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

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 WAC 284-170-431 (formerly WAC 284-43-321), the Washington payment deadline is 95% of monthly clean-claim volume paid within 30 days; 95% of monthly volume of all claims paid or denied within 60 days. A carrier failing the standard "shall pay interest on undenied and unpaid clean claims more than sixty-one days old until the carrier meets the standard," assessed at 1 percent per month, calculated monthly as simple interest and prorated for any portion of a month, added to the unpaid claim without the provider submitting an additional claim (WAC 284-170-431(2)(d)). Dental applicability: Dental carriers are reached through the carrier definition rather than the plan definition. 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: 95% of monthly clean-claim volume paid within 30 days
- Paper claims: 95% of monthly volume of all claims paid or denied within 60 days

Washington's rule is a volume standard written into provider contracts, not a per-claim deadline. Every participating provider contract must set a schedule for prompt payment and include penalties meeting these minimums: 95 percent of the monthly volume of clean claims paid within 30 days of receipt by the carrier or its agent, and 95 percent of the monthly volume of all claims paid or denied within 60 days, except as agreed in writing by the parties on a claim-by-claim basis. A clean claim is one with no defect or impropriety, including no lack of required substantiating documentation or particular circumstance requiring special treatment. Two commonly cited authorities are the wrong ones: RCW 48.43.093 is the emergency-services coverage statute and WAC 284-43-2060 is a prior-authorization rule.

## Interest and penalties on late payment

A carrier failing the standard "shall pay interest on undenied and unpaid clean claims more than sixty-one days old until the carrier meets the standard," assessed at 1 percent per month, calculated monthly as simple interest and prorated for any portion of a month, added to the unpaid claim without the provider submitting an additional claim (WAC 284-170-431(2)(d)). Because both the payment standard and the interest trigger are tied to the carrier's monthly performance rather than to one claim's due date, a per-claim estimate would misdescribe the rule. Exceptions cover fraud or misrepresentation, denied access to records, force majeure, and strikes.

## Does it apply to dental? Dental covered, with caveats

Dental carriers are reached through the carrier definition rather than the plan definition. Chapter 284-170 applies to all health plans and all health carriers subject to Washington jurisdiction, and "health carrier" includes a health care service contractor as defined in RCW 48.44.010 — the form Washington stand-alone dental carriers take. The hedge: WAC 284-170-431 never uses the word "dental," and the chapter's "health plan" definition expressly excludes dental-only and vision-only coverage, so the reach runs through the carrier prong only. The rule also binds only participating (contracted) provider claims and state-regulated carriers.

## 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

- This is a contract-standards floor: the rule requires the payment schedule and penalties to be written into the provider contract and to meet these minimums (WAC 284-170-431(1)).
- The 60-day standard is waivable "as agreed to in writing by the parties on a claim-by-claim basis."
- The rule was filed in 1999 as WAC 284-43-321 and recodified to WAC 284-170-431 effective April 23, 2016; its substance is unchanged. Chapter 284-170 shows a last update of February 4, 2026.

## Sources (statute text)

- [WAC 284-170-431 — provider contracts, terms and conditions of payment (Washington Legislature)](https://app.leg.wa.gov/wac/default.aspx?cite=284-170-431)
- [WAC 284-170-120 — application of the chapter to all health carriers](https://app.leg.wa.gov/wac/default.aspx?cite=284-170-120)
- [WAC 284-170-130 — definitions, including health carrier and health care service contractor](https://app.leg.wa.gov/wac/default.aspx?cite=284-170-130)

## 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)