ExchangeAdministrativeHigh impact
Reminder: Use Paid-through Dates to Verify Member Eligibility
Ambetter·AZ·Marketplace
Effective date
Jun 16, 2026
We identified it
Aug 26, 2026
Summary
Ambetter Health is reminding providers to verify member eligibility using paid-through dates before service delivery, as Marketplace members facing premium payment issues may enter grace periods or have coverage retroactively terminated. Providers must check member status, premium paid-through date, and claims paid-through date to avoid claim denials and reduce administrative burden.
Action Required
Immediately: Front desk and billing staff must implement enhanced eligibility verification for all Ambetter Health Marketplace members before or on the date of service. Specifically: (1) Check member eligibility status in Centene Provider portal or Availity and document the status reason (Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive); (2) Verify the premium paid-through date and claims paid-through date; (3) Flag members showing 'Active – Pending Investigation', 'Delinquent', 'Suspended', or 'Inactive' status and consider collecting payment in advance of services to reduce claim denial risk. Billing team must update encounter intake processes to require documentation of eligibility verification results before claims are submitted. Reference Ambetter's step-by-step eligibility confirmation instructions available in provider resources. Failure to verify eligibility may result in retroactive coverage termination and claim denials for services rendered during grace periods or after coverage termination.