Reminder: Use Paid-through Dates to Verify Member Eligibility

Immediately: Front desk and billing staff must implement a mandatory eligibility verification process for all Ambetter Health members at or before the date of service. Specific actions: (1) Verify member eligibility status in Centene Provider portal or Availity before each appointment; (2) Check and document the premium paid-through date and claims paid-through date; (3) Identify members with 'Active – Pending Investigation', 'Delinquent', or 'Suspended' status and collect payment in advance of services; (4) Flag any member with a claims paid-through date in the past (Suspended status) as high-risk for retroactive claim denials; (5) Update encounter workflows to require eligibility verification before scheduling or at check-in. Consequences: Failure to verify eligibility will result in increased claim denials, retroactive terminations, and write-offs for services rendered during grace periods or after coverage termination.