42 CFR 422.520 - Prompt payment by MA organization.
(a)Contract between CMS and the MA organization.
(1) The contract between CMS and the MA organization must provide that the MA organization will pay 95 percent of the “clean claims” within 30 days of receipt if they are submitted by, or on behalf of, an enrollee of an MA private fee-for-service plan or are claims for services that are not furnished under a written agreement between the organization and the provider.
(3) All other claims from non-contracted providers must be paid or denied within 60 calendar days from the date of the request.
(1)Contracts between MA organizations and providers and suppliers. Contracts or other written agreements between MA organizations and providers must contain a prompt payment provision, the terms of which are developed and agreed to by both the MA organization and the relevant provider.
(c)Failure to comply. If CMS determines, after giving notice and opportunity for hearing, that an MA organization has failed to make payments in accordance with paragraph (a) of this section, CMS may provide -
(1) For direct payment of the sums owed to providers, or MA private fee-for-service plan enrollees; and