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Medicare Advantage Prompt Pay Act

USA119th CongressS-2879| Senate 
| Updated: 9/18/2025
Catherine Cortez Masto

Catherine Cortez Masto

Democratic Senator

Nevada

Cosponsors (1)
Marsha Blackburn (Republican)

Finance Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
This bill aims to significantly improve payment timeliness for healthcare providers by Medicare Advantage (MA) organizations. It mandates that MA organizations must provide prompt payment for at least 95 percent of all "clean claims" submitted by providers and suppliers. This requirement applies to services furnished to enrollees, regardless of whether the provider is in-network or out-of-network. The bill establishes specific payment deadlines: 14 calendar days for electronically submitted claims from in-network providers and 30 calendar days for all other claims. A "clean claim" is defined as one with a complete data set according to standard forms and, for electronic submissions, compliant with applicable electronic standards. If an MA organization fails to meet these deadlines, it must pay interest to the provider, and the Secretary may impose civil money penalties of up to $25,000 for each non-compliance determination. To enhance transparency and oversight, MA organizations must provide detailed information to the Secretary regarding their prompt payment performance. This includes data on the number and percentage of claims paid on time, distinguishing between in-network and out-of-network providers, and the total interest paid due to late payments. These new requirements will take effect for items and services furnished on or after January 1, 2027.
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Timeline
Sep 18, 2025

Latest Companion Bill Action

HR 119-5454
Introduced in House
Sep 18, 2025
Introduced in Senate
Sep 18, 2025
Read twice and referred to the Committee on Finance.
  • September 18, 2025

    Latest Companion Bill Action

    HR 119-5454
    Introduced in House


  • September 18, 2025
    Introduced in Senate


  • September 18, 2025
    Read twice and referred to the Committee on Finance.

Health

Related Bills

  • HR 119-5454: Medicare Advantage Prompt Pay Act

Medicare Advantage Prompt Pay Act

USA119th CongressS-2879| Senate 
| Updated: 9/18/2025
This bill aims to significantly improve payment timeliness for healthcare providers by Medicare Advantage (MA) organizations. It mandates that MA organizations must provide prompt payment for at least 95 percent of all "clean claims" submitted by providers and suppliers. This requirement applies to services furnished to enrollees, regardless of whether the provider is in-network or out-of-network. The bill establishes specific payment deadlines: 14 calendar days for electronically submitted claims from in-network providers and 30 calendar days for all other claims. A "clean claim" is defined as one with a complete data set according to standard forms and, for electronic submissions, compliant with applicable electronic standards. If an MA organization fails to meet these deadlines, it must pay interest to the provider, and the Secretary may impose civil money penalties of up to $25,000 for each non-compliance determination. To enhance transparency and oversight, MA organizations must provide detailed information to the Secretary regarding their prompt payment performance. This includes data on the number and percentage of claims paid on time, distinguishing between in-network and out-of-network providers, and the total interest paid due to late payments. These new requirements will take effect for items and services furnished on or after January 1, 2027.
View Full Text

Suggested Questions

Get AI-generated questions to help you understand this bill better

Timeline
Sep 18, 2025

Latest Companion Bill Action

HR 119-5454
Introduced in House
Sep 18, 2025
Introduced in Senate
Sep 18, 2025
Read twice and referred to the Committee on Finance.
  • September 18, 2025

    Latest Companion Bill Action

    HR 119-5454
    Introduced in House


  • September 18, 2025
    Introduced in Senate


  • September 18, 2025
    Read twice and referred to the Committee on Finance.
Catherine Cortez Masto

Catherine Cortez Masto

Democratic Senator

Nevada

Cosponsors (1)
Marsha Blackburn (Republican)

Finance Committee

Health

Related Bills

  • HR 119-5454: Medicare Advantage Prompt Pay Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted