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.
The Prompt and Fair Pay Act establishes two major changes to how Medicare Advantage plans compensate healthcare providers. First, starting January 1, 2027, Medicare Advantage organizations must pay providers and suppliers at rates no lower than what traditional Medicare fee-for-service would pay for the same services. Second, the bill requires Medicare Advantage plans to process and pay "clean claims" (complete, error-free claims) from in-network providers within 14 days for electronically submitted claims and 30 days for paper claims, beginning in 2027. If a plan fails to meet these deadlines without notifying providers of missing information, the claim is automatically deemed clean and must be paid, plus interest accrues at the Treasury security rate plus 0.1 percentage point. The bill also requires plans to provide detailed explanations when rejecting incomplete claims and prohibits plans from retaliating against providers who pursue payment disputes. These changes aim to ensure healthcare providers receive timely, fair payments and improve patient access to care under Medicare Advantage.
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