Prompt and Fair Pay Act

Increased Provider Payment Parity: By requiring that MA organizations pay providers at least the same amount as original Medicare fee-for-service, the bill may help ensure providers are fairly compensated. This is found in Section 2.

Faster Payments to Providers: The bill requires "clean claims" to be paid within 14 days for electronic submissions and 30 days for other submissions, which ensures providers receive funds more quickly. This is found in Section 3(a)(1)(A)(iii).

Interest on Late Payments: Providers will receive interest on payments that are not issued within the required timeframe, providing a financial remedy for delays. This is found in Section 3(a)(1)(D)(i).

Better Transparency for Claim Denials: MA organizations must provide specific details on why a claim was not "clean" and give instructions on how to fix and resubmit it. This is found in Section 3(a)(1)(B)(iii).

Protection Against Retaliation: The bill prohibits MA organizations from retaliating against individuals, providers, or suppliers who exercise their legal rights under these provisions. This is found in Section 3(a)(1)(E)(ii).

Administrative Burden on MA Organizations: MA organizations must adhere to strict new notification timelines (10 to 15 days) to alert providers of claim deficiencies or the claim will be deemed "clean" and must be paid. This is found in Section 3(a)(1)(B)(ii).

Financial Penalties for MA Organizations: MA organizations face the burden of paying interest on late claims, which cannot be counted against the plan's administrative costs for medical loss ratio purposes. This is found in Section 3(a)(1)(D)(i).