Reminder: Use Paid-through Dates to Verify Member Eligibility

Effective immediately (06/05/26): Front desk and billing staff must verify Ambetter Health member eligibility for every patient at or as close to date of service as possible. (1) Check member status in Centene Provider portal or Availity and confirm one of four statuses: Active (paid in full), Active – Pending Investigation (behind on premiums), Delinquent (behind on premiums with future paid-through date), Suspended (behind on premiums with past paid-through date), or Inactive (terminated). (2) Verify and document the premium paid-through date and claims paid-through date in the patient record. (3) Flag any member with Delinquent or Suspended status and inform the provider before service delivery so payment can be collected in advance if appropriate. (4) Do NOT bill claims for members with Inactive status or after the claims paid-through date has passed, as claims will be denied retroactively and previous claims may be reversed. (5) Update front desk eligibility verification workflows and billing system reminders to include these three data points for all Ambetter members. Failure to verify eligibility will result in increased claim denials, payment reversals, and administrative rework.