Medicare Advantage Prompt Pay Act
Analysis under review: This bill has generated analysis that may be too generic or incomplete. Clause-level evidence remains available below.
Summary
What This Bill Does
The bill requires Medicare Advantage organizations to pay at least 95% of clean claims within 14 days (electronic in-network) or 30 days (other claims), regardless of in-network/out-of-network status. It relies on compliance mandates, reporting requirements, and product standards. The main policy areas are Healthcare and Finance.
Who Benefits and How
Physician practices and medical groups with MA patients could see lower costs, Hospitals treating Medicare Advantage patients could see lower costs, and Healthcare IT vendors providing claims processing systems could gain revenue opportunities.
Who Bears the Burden and How
Medicare Advantage organizations (private insurers offering MA plans) would take on compliance duties and Medicare Advantage insurers with high claim volumes could face higher costs.
Key Provisions
- Requires Medicare Advantage organizations to pay at least 95% of clean claims within 14 days (electronic in-network) or 30 days (other claims), regardless of in-network/out-of-network status.
Evidence Chain:
This summary is generated from the full bill text using AI analysis. Expand "Detailed Analysis" below for identified beneficiaries/burden bearers with clause-level evidence links.
At a Glance
What This Bill Does
The bill requires Medicare Advantage organizations to pay at least 95% of clean claims within 14 days (electronic in-network) or 30 days (other claims), regardless of in-network/out-of-network status.
Key Policy Areas
Healthcare, Finance
Primary Purpose
The bill requires Medicare Advantage organizations to pay at least 95% of clean claims within 14 days (electronic in-network) or 30 days (other claims), regardless of in-network/out-of-network status.
Policy Domains
S.2879-119 (Entire Bill)
Identified Gains
- Physician practices and medical groups with MA patients
- Hospitals treating Medicare Advantage patients
- Healthcare IT vendors providing claims processing systems
Identified Costs
- Medicare Advantage organizations (private insurers offering MA plans)
- Medicare Advantage insurers with high claim volumes
Sponsors
Legislative Progress
In CommitteeMs. Cortez Masto (for herself and Mrs. Blackburn) introduced the …
Read twice and referred to the Committee on Finance.
Introduced in Senate
Stakeholder Effects
cui bono?How this legislation distributes effects. Mention counts reflect frequency, not effect magnitude.
Medicare Advantage insurers with high claim volumes, Medicare Advantage organizations (private insurers offering MA plans)
Healthcare IT vendors providing claims processing systems, Hospitals treating Medicare Advantage patients
Physician practices and medical groups with MA patients
Bill Structure & Actor Mappings
Who is "The Secretary" in each section?
- "the_secretary"
- → Secretary of Health and Human Services
- "ma_organization"
- → Medicare Advantage organization (private insurer offering Medicare Advantage plans)
- "provider_of_services"
- → Healthcare providers and suppliers furnishing services to Medicare Advantage enrollees
Key Definitions
Terms defined in this bill
A claim with a complete UB-04 or CMS 1500 data set for all mandatory entries, and if submitted electronically, completed in accordance with standards adopted under section 1173(a)
Electronic claims: date verified in health care claim status request/response transaction. Non-electronic: fifth business day after postmark or transmission timestamp
14 days for electronic claims from in-network providers; 30 days for all other claims (electronic out-of-network or non-electronic claims)
Any day other than Saturday, Sunday, or a legal public holiday under 5 USC 6103
We use a combination of our own taxonomy and classification in addition to large language models to assess meaning and potential beneficiaries. High confidence means strong textual evidence. Always verify with the original bill text.
Learn more about our methodology