Medicare Advantage Prompt Pay Act

The Medicare Advantage Prompt Pay Act aims to enhance payment timeliness for healthcare providers by amending the Social Security Act. It requires Medicare Advantage (MA) organizations to ensure prompt payment for a minimum of 95 percent of clean claims submitted by providers and suppliers. This applies to both in-network and out-of-network services, ensuring broader coverage for payment efficiency. The bill establishes specific deadlines for these payments: 14 calendar days for electronically submitted claims from contracted providers and 30 calendar days for all other claims. A "clean claim" is defined as one with a complete data set and, if electronic, compliant with applicable standards. To enforce these requirements, MA organizations will incur interest penalties for any clean claims not paid by the specified deadlines, calculated at the federal prompt payment rate. Furthermore, the legislation grants the Secretary of Health and Human Services authority to impose civil money penalties of up to $25,000 for each instance of non-compliance with these prompt payment standards. To ensure transparency and oversight, MA plans will be required to provide detailed information regarding their prompt payment performance. This includes data on the number and percentage of claims paid, those paid by the deadline, and the total amount of interest paid due to late payments, with these provisions taking effect for services furnished on or after January 1, 2027.