119th (2025–2027)
H.R. 5454
The Medicare Advantage Prompt Pay Act would require Medicare Advantage insurance plans to pay healthcare providers faster for submitted claims. Specifically, plans must pay at least 95 percent of clean claims (complete, error-free claims) within 14 days for electronically submitted claims from contracted providers, or within 30 days for all other claims. If plans miss these deadlines, they must pay interest to providers at the same rate the federal government pays when it makes late payments. The bill also creates civil penalties of up to $25,000 per violation if the federal government determines a plan is not complying with these requirements, and requires plans to publicly report detailed information about their claim payment performance. These new requirements would take effect on January 1, 2027, for items and services furnished on or after that date.