How soon must a dental plan or insurer pay submitted claims ?

Both the California Insurance Code, which regulates indemnity insurance and most preferred provider organizations, and the California Health and Safety Code, which regulates health care service plans, contain 'prompt-payment' provisions that require payment of complete or 'clean' claims within 30 working days or 45 days if the plan is a health maintenance organization (HMO). Clean claims are those for which no additional documentation (e.g., X-rays, treatment notes) is required. Claim payments that arrive later than the prompt-pay requirements should include interest penalties (15 percent per annum for managed care plans regulated by the Department of Managed Health Care (DMHC) and 10 percent per annum for preferred provider organizations and indemnity insurers regulated under the Department of Insurance).

Dental CPT Code Lookup.

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