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

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

Wisconsin prompt-pay law for dental claims

Wisconsin's prompt-pay law reaches dental claims with caveats. Clean claims must be paid or denied within 30 days; late payment accrues statutory interest.

Wis. Stat. §628.46 (claim classes via §646.31(2))

Read the statute text

Payment deadlines

Electronic claims: 30 days (no format split)
Paper claims: 30 days (no format split)

"A claim shall be overdue if not paid within 30 days after the insurer is furnished written notice of the fact of a covered loss and of the amount of the loss" (§628.46(1)) — one unified standard with no electronic-versus-paper split. Subsection (2) adds the practical hedge: notwithstanding subsection (1), payment is not overdue until 30 days after the insurer receives the proof of loss required under the policy or equivalent evidence. Payment counts as made on the date a valid instrument was placed in the mail, properly addressed and postpaid, or otherwise on delivery.

Interest and penalties

Overdue payments bear simple interest at 7.5 percent per year (§628.46(1)). The condition to watch is what makes a payment overdue: "any payment shall not be deemed overdue when the insurer has reasonable proof to establish that the insurer is not responsible for the payment." A genuinely disputed claim backed by reasonable proof never becomes overdue, so interest never starts. The 12 percent figure in older references was superseded by 2017 Wis. Act 235.

Does it apply to dental? Dental covered, with caveats

The section opens broadly — "Unless otherwise provided by law, an insurer shall promptly pay every insurance claim" — but subsection (3) limits it: "This section applies only to the classes of claims enumerated in s. 646.31 (2)." Those classes are residency-based, starting with the claim of a policyholder or insured who is a resident of Wisconsin, and extending to nonresident, property, third-party, assignee, beneficiary, and structured-settlement classes. Dental claims of Wisconsin-resident insureds and policyholders fall inside class (a), which is how dental is reached — state the scope that way rather than as "every claim, any insurer." A chiropractic-specific rule in subsection (2m) does not generalise to dentistry.

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 Wisconsin rule (Wis. Stat. §628.46 (claim classes via §646.31(2))). 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 (30 days (no format split)), not days since submission.

Estimated interest

$7.86

7.5% per year (simple)

"All overdue payments shall bear simple interest at the rate of 7.5 percent per year." Older sources quoting 12% are stale — 2017 Wis. Act 235 set the current rate. A payment is not overdue at all where the insurer has reasonable proof that it is not responsible for it, so interest is not unconditional.

How we calculate this

Formula: claim × 7.5% × days late ÷ 365, using simple (not compounded) interest as the statute states it. The rate and deadline come from Wis. Stat. §628.46 (claim classes via §646.31(2)), 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

The statute has been held to apply to service insurance corporations (Wisconsin Physicians Service Ins. Corp. v. Mitchell, 114 Wis. 2d 338 (Ct. App. 1983)).
Currency: 2023–24 Wisconsin Statutes updated through 2025 Wis. Act 247 and Supreme Court orders in effect on August 5, 2026; last substantive amendment 2017 Wis. Act 235.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental covered, with caveats

Estimate the late-payment interest

Also in the statute

Sources (statute text)