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Reminder: Use Paid-through Dates to Verify Member Eligibility
Act
immediately
Effective date
Not stated in the notice
Identified
Aug 26, 2026
Summary
Ambetter Health is reminding providers to verify member eligibility using paid-through dates before service delivery, particularly for Marketplace members affected by premium payment issues. Providers must check member status, premium paid-through date, and claims paid-through date to avoid claim denials and reduce administrative burden. Members in grace periods or with delinquent/suspended status may have retroactive coverage termination and previous claims denied.
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What to do
immediately · 6 steps
01Billing team must implement pre-service eligibility verification procedures for all Ambetter Health Marketplace members.
02Train front desk and billing staff to verify member status on or as close to the date of service as possible using the Centene Provider portal or Availity.
03Verify THREE data points: member eligibility status, premium paid-through date, and claims paid-through date.
04Understand status codes: Active (paid in full), Active – Pending Investigation (Availity only; behind on premiums), Delinquent (behind on premiums, claims paid through date in future), Suspended (behind on premiums, claims paid through date in past), and Inactive (coverage terminated).
05For members showing Delinquent or Suspended status, collect payment in advance of services or flag for pre-authorization review.
06Document verification results in patient record.
If missed: Failure to verify eligibility will result in denied claims, retroactive coverage terminations dating back to missed premium payment, and increased claim denials for services already rendered.
Original notice
Reminder: Use Paid-through Dates to Verify Member Eligibility
ambetterhealth.com · Always check the source before changing claims.
Related changes
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