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Reminder: Use Paid-through Dates to Verify Member Eligibility
Effective date
Not stated in the notice
Identified
Nov 3, 2026
Summary
This is a historical reminder (published 2026-06-05, discovered 2026-11-03) that Ambetter Health Marketplace members must maintain current premium payments to keep coverage active. The practice should verify member eligibility status and paid-through dates before service delivery to reduce denied claims, as members in grace period or with missed payments may have coverage retroactively terminated and prior claims denied.
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What to do
Action · 6 steps
01Billing team and front desk staff should update eligibility verification procedures to check member status, premium paid-through date, and claims paid-through date before each service.
02When verifying eligibility in the Centene Provider portal or Availity, note the member's status (Active, Active – Pending Investigation, Delinquent, Suspended, or Inactive) and the paid-through dates.
03If a member shows Delinquent or Suspended status, alert the provider and consider collecting payment in advance of service to reduce the risk of denied claims if coverage is retroactively terminated.
04Document the eligibility verification date and status in the patient record.
05This is an ongoing best practice reminder; no future deadline is stated.
06Confirm the practice is already following these steps to minimize exposure to retroactive claim denials on Ambetter Marketplace plans.
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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