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

Under 24-A M.R.S. §2436, the Maine payment deadline is 30 days (after proof of loss and ascertainment). An overdue claim, or the overdue part of one, bears interest at 1.5 percent per month after the due date (§2436(3)); the superintendent adopts routine technical rules setting a minimum interest amount payable to a health care provider before a payment must be issued. Dental applicability: Covered, with dental named in the statute. 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.

Dental expressly covered · Last verified 2026-08-30

Maine prompt-pay law for dental claims

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

24-A M.R.S. §2436

Read the statute text

Payment deadlines

Electronic claims: 30 days (after proof of loss and ascertainment)
Paper claims: 30 days (after proof of loss and ascertainment)

A claim under a policy delivered or issued for delivery in Maine is payable within 30 days after proof of loss is received and ascertainment of the loss is made; a claim neither disputed nor paid within 30 days is overdue. A written request for reasonable additional information restarts the clock — 30 days from receipt of that information. Providers may submit a claim simultaneously to every carrier potentially liable, primary or secondary, and each carrier must pay or deny within 30 days of having what it needs, whether or not the other carrier has acted.

Interest and penalties

An overdue claim, or the overdue part of one, bears interest at 1.5 percent per month after the due date (§2436(3)); the superintendent adopts routine technical rules setting a minimum interest amount payable to a health care provider before a payment must be issued. Interest runs only on undisputed claims: §2436(2-C) makes a provider claim undisputed only when it has all data elements, is not materially deficient including missing substantiating documentation, and presents no unusual circumstances. Attorney's fees are unusually reachable — the insurer must pay a reasonable fee if overdue benefits are recovered in an action or simply paid after it receives notice of the attorney's representation (§2436(4)).

Does it apply to dental? Dental expressly covered

Covered, with dental named in the statute. Subsection 1-A provides that "'health care provider' includes a person licensed to provide dental care services under Title 32, chapter 143, subchapter 3 and 'carrier' includes an insurer that provides dental insurance." Those definitions are prefaced "For the purposes of this subsection" — the simultaneous-billing and EFT subsection — so quote them with that scope; dental policies fall under the general 30-day rule as insurance in any event. Long-term care insurance claims are the section's one express exclusion (§2436(6)).

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 Maine rule (24-A M.R.S. §2436). 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 (after proof of loss and ascertainment)), not days since submission.

Estimated interest

$19.13

1.5%/mo (monthly tiers, prorated by days)

1.5% per month after the due date. The superintendent sets by rule a minimum interest amount payable on an overdue undisputed provider claim before a payment must be issued, so very small amounts may be held back.

How we calculate this

Formula: claim × monthly tier rate × days in tier ÷ 30, summed across tiers, using simple (not compounded) interest as the statute states it. The rate and deadline come from 24-A M.R.S. §2436, 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

On request, a carrier must offer a health care provider a claims-payment method using electronic funds transfer through the automated clearinghouse network (§2436(1-A)).
While a deficiency is being rectified and resubmitted, the provider may not bill the patient (§2436(2-B)).
The statute draws no in-network / out-of-network distinction; it applies to any policy or certificate delivered or issued for delivery in Maine.
Provider complaints run through the Bureau of Insurance's Independent Health Care Provider complaint process under the §4329 liaison program, not through §2436 itself.
Last amended by PL 2025, c. 300, §1, which amended the subsection carrying the dental definitions.

Payment deadlines

Interest and penalties

Does it apply to dental? Dental expressly covered

Estimate the late-payment interest

Also in the statute

Sources (statute text)