ExchangeAdministrativeHigh impact
Reminder: Use Paid-through Dates to Verify Member Eligibility
Ambetter·NH·Marketplace
Effective date
May 28, 2026
We identified it
Aug 26, 2026
Summary
Ambetter Health is reminding providers to verify member eligibility using paid-through dates before service delivery, as Marketplace members missing premium payments enter grace periods (up to 90 days) and may face retroactive coverage termination and claim denials. Providers must check member status, premium paid-through date, and claims paid-through date to reduce denied claims and clarify advance payment collection.
Action Required
Immediately and ongoing: Front desk staff and billing team must verify Ambetter Health member eligibility status on or as close to the date of service as possible using the Centene Provider portal or Availity. Confirm three data points for each member: (1) eligibility status (Active, Active-Pending Investigation, Delinquent, Suspended, or Inactive), (2) premium paid-through date, and (3) claims paid-through date. Update intake and pre-service verification workflows to require documentation of these three checks before claim submission. Train staff to recognize that Delinquent status (claims paid-through date in future) and Suspended status (claims paid-through date in past) indicate non-payment and potential retroactive termination risk. Implement process to collect advance payment from members in Delinquent or Suspended status before service delivery. Failure to verify eligibility will result in increased claim denials due to retroactive termination and grace period coverage gaps.