ExchangeAdministrativeMedium impact
Implementation of Site of Care Optimization Program for Ambetter Health Members: Effective 10/01/2026
Ambetter·MO · Oncology, Hematology, Infectious Disease +1 more·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Aug 26, 2026
Summary
Effective October 1, 2026, Ambetter Health will implement a Site of Care Optimization Program requiring providers to transition eligible members receiving infusions from outpatient hospital settings to lower-cost alternatives such as home infusion or ambulatory infusion suites. Providers will receive outreach beginning in September 2026 requesting site-of-care selections for individual members. This is a care coordination and referral workflow change, not a billing code or coverage change.
Action Required
By September 2026: Billing and clinical teams should prepare for outreach from Ambetter Health care coordination team regarding member-specific infusion site-of-care selections. Designate a point person to receive fax/phone outreach and coordinate responses. Update internal referral processes to include in-network home infusion and ambulatory infusion suite (AIS) options. Before October 1, 2026: Train billing and clinical staff on the new site-of-care optimization program requirements. Ensure EMR/billing system can track and document site-of-care designations for affected members to prevent billing to high-cost outpatient hospital settings when alternative sites are approved. Engage with Ambetter's care coordination team at (866) 861-6269 to clarify member eligibility, referral processes, and coverage considerations for transitions. Failure to comply may result in claim denials or retrospective claim adjustments if services are billed to inappropriate high-cost settings after alternative sites are designated.