Medicare Advantage Prompt Pay Act

This bill amends the Social Security Act to require Medicare Advantage organizations to pay at least 95% of clean claims within 14 days for electronic claims from contracted providers or 30 days for other claims, with interest penalties for late payments and civil money penalties of up to $25,000 per violation. It also requires plans to disclose compliance data to enrollees.

Sec. 2, Prompt payment requirements: Medicare Advantage contracts must require prompt payment for at least 95% of clean claims within 14 calendar days for electronic claims from contracted providers or suppliers, and within 30 calendar days for all other claims. A clean claim is defined as one with a complete data set on the UB-04 or CMS 1500 form (or successor) for mandatory entries, and for electronic claims, completed per applicable standards. There is a rebuttable presumption that an electronic claim is received on the date verified in a health care claim status transaction, and a paper claim is received on the fifth business day after postmark or transmission timestamp. If payment is not made by the deadline, the organization must pay interest at the rate used for federal prompt payment penalties, from the day after the required payment date until payment is made. The Secretary must impose civil money penalties of up to $25,000 for each determination of noncompliance, in addition to other remedies, and may consider information collected from plans. These amendments apply to items and services furnished on or after January 1, 2027, and contract years beginning on or after that date.

Sec. 2, Information disclosure: Medicare Advantage plans must provide enrollees with information on compliance with prompt payment requirements for the most recent 12-month period, including the number and percent of submitted claims paid, the number and percent of claims for contracted and non-contracted providers, the number and percent of such claims paid by the deadline, the number and percent for which interest was paid, and the total amount of interest paid.