Utah prompt-pay law for dental claims

Does it apply to dental? Dental expressly covered

Covered. "Health care provider" means a person licensed to provide health care under Title 26B, Chapter 2, Part 2 or under Title 58, Occupations and Professions — and dentists are licensed under Title 58, Chapter 69, the Dentist and Dental Hygienist Practice Act. The section also speaks of "a dental insurer" directly in subsection (16)(e). "Insurer" covers admitted or authorised insurers including health maintenance organizations and third-party administrators subject to the title. The Medicaid carve-out that circulates for Utah is narrow: it applies only to the subsection (7) explanation-of-benefits duties, not to the section as a whole.

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.