Reminder: Use Paid-through Dates to Verify Member Eligibility

Immediately (effective 05/28/26): Billing team and front desk staff must implement real-time eligibility verification for all Ambetter Health Marketplace members before or at the date of service. (1) Update registration workflow to require staff to verify member status in the Centene Provider portal or Availity, checking for Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive status. (2) Document the premium paid-through date and claims paid-through date on the patient record or encounter form. (3) Flag and escalate any members showing Delinquent or Suspended status (indicating past-due premiums) for advance payment collection before service delivery. (4) Train all patient-facing staff on the new status definitions and escalation procedures. (5) For claims already submitted for members who were later found to be in grace period or terminated status, anticipate potential denials and prepare member communications. Failure to verify eligibility will result in increased claim denials, retroactive coverage terminations, and bad debt from members.