# West Virginia prompt-pay law for dental claims

> What is the West Virginia prompt-pay deadline for dental claims, and what interest applies to late payment? Read against the statute text (W. Va. Code §33-45-2; §33-45-3).

URL: https://dentovio.com/dental-prompt-pay-laws/west-virginia

Last verified: 2026-08-30

Dentovio is an independent publisher, not a law firm, insurance department, or government agency. This page was drafted with AI assistance and read against the primary sources linked here, with a per-claim verification record — quote, statutory pinpoint, and the URL actually opened — behind every deadline, rate, and applicability verdict in all fifty-one jurisdictions. It has not been reviewed by a credentialed attorney or dental billing specialist. These pages summarize state prompt-pay statutes as read against the official sources on the date shown, focusing on how each statute treats dental claims. Statutes change and their application turns on plan type, contract status, and claim facts. Educational reference only — not legal advice; confirm current law with the state insurance department or a licensed attorney before acting on a specific claim.

## Direct answer

Under W. Va. Code §33-45-2; §33-45-3, the West Virginia payment deadline is 30 days (submitted electronically) and 40 days (submitted manually). "Interest, at a rate of 10 percent per annum, accruing after the 40-day period provided in §33-45-2(a)(1) of this code owing or accruing on any claim under any provider contract or under any applicable law, shall be paid and accompanied by an explanation of the assessment on each claim of interest paid, without necessity of demand, at the time the claim is paid or within 30 days thereafter" (§33-45-2(a)(4)). Dental applicability: Covered. 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.

## Payment deadlines

- Electronic claims: 30 days (submitted electronically)
- Paper claims: 40 days (submitted manually)

An insurer must pay or deny a clean claim within 40 days of receipt if submitted manually and within 30 days if submitted electronically, with five statutory exceptions: another payor or party is responsible, benefits are being coordinated, the provider has already been paid, the claim was submitted fraudulently, or there was a material misrepresentation. Non-clean claims run on a separate 30-day information-request and adjudication track, and a failure caused materially by the submitter — or by force majeure — is excused. These duties are contract terms: every provider contract entered into, amended, extended, or renewed on or after August 1, 2001 must contain them.

## Interest and penalties on late payment

"Interest, at a rate of 10 percent per annum, accruing after the 40-day period provided in §33-45-2(a)(1) of this code owing or accruing on any claim under any provider contract or under any applicable law, shall be paid and accompanied by an explanation of the assessment on each claim of interest paid, without necessity of demand, at the time the claim is paid or within 30 days thereafter" (§33-45-2(a)(4)). Read that carefully before quoting it: the accrual trigger is the 40-day period for every claim, including electronic ones. West Virginia also gives providers an express private right of action — §33-45-3 entitles a provider who suffers loss from a violation to "initiate an action to recover actual damages." Actual damages only: despite the section heading, the operative text contains no attorney-fee or cost-shifting language.

## Does it apply to dental? Dental expressly covered

Covered. The duty attaches to claims "for health care services rendered pursuant to a provider contract," health care services means items or services furnished to any individual for preventing, alleviating, curing, or healing human illness, injury, or physical or mental disability, and "provider" means a person or entity holding a valid licence or permit under chapter 30 of the code — where dentists are licensed. The scope limit is the payer side: "health plan" excludes Medicare, Medicaid, CHAMPUS, FEHB, PEIA, accident-only, credit, disability, long-term care, Medicare supplement, workers' compensation, and article-16E limited-benefit policies, so this is a commercial provider-contract rule, not a government-program rule.

## 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.

## Also in the statute

- Most retroactive denials carry a one-year lookback limit; fraud or material misrepresentation has no time limit (§33-45-2(a)(7)(C)).
- "Insurer" includes third-party administrators of health insurance, entities operating a health plan subject to the chapter, entities arranging health care services through networks or provider panels, and intermediaries.
- Section 33-45-2 was last amended in 2019 (HB 2954); §33-45-3 has not been amended since its 2001 enactment.

## Sources (statute text)

- [W. Va. Code §33-45-2 — minimum fair business standards for claim payment](https://code.wvlegislature.gov/33-45-2/)
- [W. Va. Code §33-45-3 — provider action for actual damages](https://code.wvlegislature.gov/33-45-3/)
- [W. Va. Code §33-45-1 — definitions of insurer, provider, and health care services](https://code.wvlegislature.gov/33-45-1/)

## Related

- [All state prompt-pay pages](https://dentovio.com/dental-prompt-pay-laws/index.html.md)
- [Dental claim denial codes](https://dentovio.com/dental-claim-denial-codes/index.html.md)
- [Payer documentation requirements](https://dentovio.com/dental-claim-documentation/index.html.md)