What does Preamble of Medicare Advantage Prompt Pay Act do?

This bill, formally titled 'A bill to amend title XVIII of the Social Security Act to apply improved prompt payment requirements to Medicare Advantage organizations,' aims to modify the Social Security Act. The proposed legislation intends to apply improved prompt payment requirements to Medicare Advantage organizations.

What does SHORT TITLE. of Medicare Advantage Prompt Pay Act do?

This bill is formally titled the Medicare Advantage Prompt Pay Act.

What does APPLICATION OF IMPROVED PROMPT PAYMENT REQUIREMENTS TO MEDICARE of Medicare Advantage Prompt Pay Act do?

This section amends Section 1857 of the Social Security Act to modify requirements for prompt payment by Medicare Advantage organizations. Medicare Advantage organizations are required to pay not less than 95 percent of clean claims within 14 days for electronically submitted claims and 30 days for other claims. A 'clean claim' is defined as one with a complete data set and, for electronic submissions, compliance with applicable standards. There is a rebuttable presumption that a claim is received on a specific date based on electronic verification or the postmark date. If payment is not made by the deadline, the Medicare Advantage organization must pay interest at a rate specified in title 31 of the United States Code. The Secretary can impose civil money penalties of up to $25,000 for non-compliance with prompt payment requirements. Medicare Advantage organizations must provide information regarding compliance with prompt payment requirements, including data on submitted claims, payment timeliness, and interest paid.

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Medicare Advantage Prompt Pay Act

Last updated: 9/18/2025 · Introduced: 9/18/2025

Author: Catherine Cortez Masto (D-NV)

TL;DR (AI)

This bill requires Medicare Advantage organizations to pay at least 95% of clean claims within 14 days for electronic submissions and 30 days for other submissions.
Medicare Advantage organizations that fail to meet these payment deadlines must pay interest on late payments and may face civil money penalties of up to $25,000.
Medicare Advantage organizations must report data on claim submissions, payment timeliness, and interest paid to ensure compliance with prompt payment requirements.

119th Congressin committeeHR. 5454(In Committee)Official page

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Other Sections

Includes provisions on preamble, short title., and 1 more.

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