US SB2879

Medicare Advantage organizations must provide prompt payment for at least 95% of clean claims submitted by healthcare providers, within 14 days for electronic in-network claims and 30 days for all other claims

Clean claims are defined as those with complete data on UB-04 or CMS 1500 forms meeting National Uniform Billing Committee standards, with electronic claims also required to meet HIPAA transaction standards

Organizations that miss payment deadlines must pay interest to providers at the federal prompt payment penalty rate (per 31 U.S.C. 3902(a)) from the day after the deadline until payment is made

Civil money penalties of up to $25,000 per violation may be imposed on Medicare Advantage organizations that fail to comply with the prompt payment requirements

Medicare Advantage plans must publicly report compliance data including the percentage of claims paid on time, broken down by in-network and out-of-network providers, and total interest paid for late payments