Prompt and Fair Pay Act

This bill sets fair-pay and fast-pay rules for Medicare Advantage plans. Starting in 2027, these plans must pay doctors, hospitals, and other providers at least the same amount that traditional Medicare would pay for the same service, to help keep networks stable and protect patient access to care.

It also creates strict timelines for paying in-network claims. If a provider sends a clean claim (a claim without missing info or errors), the plan must pay within 14 days for electronic claims or 30 days for others; if the plan doesn’t pay or contest in time, it must pay the claim. Late payments owe interest, and providers can request payment by electronic funds transfer. Plans must quickly tell providers if a claim has problems and explain exactly what to fix and how. The bill bars retaliation for people who exercise their rights and gives the government power to enforce these prompt‑pay rules .

Key points

• Who is affected: People with Medicare Advantage, in‑network doctors and other providers, and Medicare Advantage plans.
• What changes: Payment must be at least the traditional Medicare rate; clean claims must be paid on time; late payments owe interest; electronic payment available on request; detailed, timely notice required if a claim has issues; federal enforcement of these rules .
• When: Applies to plan years starting January 1, 2027.