Bill > HR5454

This bill amends Medicare Advantage (MA) regulations to establish stricter prompt payment requirements for MA organizations when processing healthcare claims. Specifically, the bill requires MA organizations to pay at least 95 percent of "clean claims" (claims with complete and accurate information) within 14 days for electronically submitted claims and 30 days for paper claims. If an MA organization fails to pay a clean claim by the specified deadline, they must pay interest to the healthcare provider at a standard federal rate. The bill also introduces civil money penalties of up to $25,000 for organizations that do not comply with these prompt payment requirements. Additionally, MA organizations will be required to report detailed information about their claim payment practices, including the number and percentage of claims paid, the types of claims, payment timeliness, and total interest paid. These new requirements will take effect for items and services furnished on or after January 1, 2027, giving healthcare providers and MA organizations time to adapt to the new regulations.

Budget and Finance

https://www.congress.gov/bill/119th-congress/house-bill/5454/all-info