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Medicare Advantage Prompt Pay Act

USA119th CongressHR-5454| House 
| Updated: 9/18/2025
Jodey C. Arrington

Jodey C. Arrington

Republican Representative

Texas

Cosponsors (6)
Marc A. Veasey (Democratic)Nathaniel Moran (Republican)Rudy Yakym (Republican)Carol D. Miller (Republican)August Pfluger (Republican)Linda T. Sánchez (Democratic)

Ways and Means Committee, Energy and Commerce Committee

  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted
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.
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Timeline
Sep 18, 2025

Latest Companion Bill Action

S 119-2879
Introduced in Senate
Sep 18, 2025
Introduced in House
Sep 18, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
  • September 18, 2025

    Latest Companion Bill Action

    S 119-2879
    Introduced in Senate


  • September 18, 2025
    Introduced in House


  • September 18, 2025
    Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.

Health

Related Bills

  • S 119-2879: Medicare Advantage Prompt Pay Act

Medicare Advantage Prompt Pay Act

USA119th CongressHR-5454| House 
| Updated: 9/18/2025
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.
View Full Text

Suggested Questions

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

Timeline
Sep 18, 2025

Latest Companion Bill Action

S 119-2879
Introduced in Senate
Sep 18, 2025
Introduced in House
Sep 18, 2025
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
  • September 18, 2025

    Latest Companion Bill Action

    S 119-2879
    Introduced in Senate


  • September 18, 2025
    Introduced in House


  • September 18, 2025
    Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Jodey C. Arrington

Jodey C. Arrington

Republican Representative

Texas

Cosponsors (6)
Marc A. Veasey (Democratic)Nathaniel Moran (Republican)Rudy Yakym (Republican)Carol D. Miller (Republican)August Pfluger (Republican)Linda T. Sánchez (Democratic)

Ways and Means Committee, Energy and Commerce Committee

Health

Related Bills

  • S 119-2879: Medicare Advantage Prompt Pay Act
  • Introduced
  • In Committee
  • On Floor
  • Passed Chamber
  • Enacted