Pennsylvania prompt-pay law for dental claims

Does it apply to dental? Standalone dental excluded

Dental-only carriers are outside the article. An Article XXI "insurer" is an entity licensed by the department that offers, issues, or renews an individual or group health insurance policy, and §2102 defines "health insurance policy" as a policy issued by an insurer that provides medical or health care coverage, expressly excluding "a dental only policy." So a claim to a Pennsylvania dental-only carrier does not carry the 45-day deadline or the 10 percent interest. The dental carve-out sometimes cited from the EMS billing section (§635.7) is the wrong anchor — that section's definitions apply only within it.

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.