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Reminder: Use Paid-through Dates to Verify Member Eligibility
Effective date
Not stated in the notice
Identified
Nov 2, 2026
Summary
Ambetter Health (Centene) reminds providers to verify member eligibility using paid-through dates before service delivery, as Marketplace members in grace periods or with delinquent premiums may have coverage retroactively terminated, resulting in claim denials. Providers must check eligibility status, premium paid-through date, and claims paid-through date to reduce denied claims and clarify advance payment collection.
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What to do
Action · 8 steps
01Billing and front desk staff must check Ambetter Health member eligibility on or as close to the date of service as possible by.
02Verifying member status in the Centene Provider portal or Availity, noting the specific status reason (Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive).
03Confirming the premium paid-through date and claims paid-through date.
04Identifying members with Delinquent status (behind on premiums with future claims paid-through date) or Suspended status (behind on premiums with past claims paid-through date) who may have coverage gaps or retroactive termination.
05Collecting advance payment from the member before service delivery when eligibility is uncertain or coverage may be terminated retroactively.
06Update front desk check-in procedures and charge entry workflows to require eligibility verification before scheduling and billing.
07Tell providers and staff that claims submitted for members with lapsed coverage or during grace periods will be denied, and that retroactive terminations may result in previous claims being denied.
08Resubmit or appeal claims that were denied due to retroactive coverage termination once the member's status is clarified.
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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