H.R. 5454 — Medicare Advantage Prompt Pay Act

This section requires Medicare Advantage (MA) organizations to pay at least 95% of clean claims for enrollee-covered items and services within 14 calendar days (electronic claims from contracted providers/suppliers) or 30 calendar days (other claims), with interest penalties under 31 U.S.C. 3902(a) for late payments and civil money penalties of up to $25,000 per determination of noncompliance. It also requires MA plans to publicly report specified compliance metrics (e.g., percent of claims paid on time or with interest, total interest paid) for the most recent 12-month period. The requirements apply to items and services furnished and contract years beginning on or after January 1, 2027.