Reminder: Use Paid-through Dates to Verify Member Eligibility

Immediately: Billing and front desk staff must implement mandatory eligibility verification for all Ambetter Health Marketplace members at point of service or as close to date of service as possible. Implement the following verification protocol: (1) Check member eligibility status in Centene Provider portal or Availity and document the status (Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive); (2) Verify the premium paid-through date and claims paid-through date for each member; (3) Update intake forms and encounter documentation to require staff to record eligibility verification results; (4) Train all front desk and billing staff on the new status codes and their implications (particularly Delinquent and Suspended statuses which indicate payment issues); (5) Flag for advance payment collection any members showing behind-on-premium status before services are rendered. Failure to verify eligibility may result in claim denials, retroactive coverage termination, and increased administrative burden from denied claims requiring reprocessing.