“A bill to amend title XVIII of the Social Security Act to apply improved prompt payment requirements to Medicare Advantage organizations.”
No CRS summary available for this bill.
This section requires Medicare Advantage (MA) organizations to make prompt payment of at least 95% of clean claims (i.e., claims with complete mandatory data elements per UB-04/CMS 1500 forms or electronic standards) for enrollee-covered items and services—within 14 calendar days for electronic claims from contracted providers/suppliers and 30 days for other claims—with interest penalties under 31 U.S.C. §3902(a) for late payments and rebuttable presumptions for claim receipt dates. It further authorizes civil money penalties (CMPs) of up to $25,000 per determination of noncompliance (using data under SSA §1851(d)(4)(D)(v)) and requires public reporting of plan-level prompt payment metrics (e.g., claims paid on time, interest paid amounts) for the prior 12 months. The requirements apply to items and services furnished, and contract years beginning, on or after January 1, 2027.