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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 reinforcing the importance of verifying member eligibility using paid-through dates before providing services, particularly for Marketplace members affected by premium payment issues. Providers must proactively check eligibility status, premium paid-through dates, and claims paid-through dates to avoid claim denials and retroactive coverage terminations. Members in grace periods or with delinquent status may have claims denied if premiums aren't paid within 90 days.
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What to do
immediately · 4 steps
01Billing team and front desk staff must implement proactive eligibility verification for all Ambetter Health Marketplace members on or before the date of service.
02Before each appointment, verify member status in the Centene Provider portal or Availity, documenting the eligibility status (Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive), the premium paid-through date, and the claims paid-through date.
03Train staff to identify members in grace periods or with delinquent status and collect outstanding premiums in advance of services when possible.
04Update intake processes to flag any member with a paid-through date that does not align with the service date.
If missed: Failure to verify eligibility may result in denied claims and retroactive coverage terminations, requiring staff to pursue collection from members.
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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