← Back to list
Implementation of Site of Care Optimization Program for Ambetter Health Members
Act
by Jan 1, 2027
Effective date
Jan 1, 2027
Identified
Nov 4, 2026
Summary
Effective January 1, 2027, Ambetter Health will implement a Site of Care Optimization Program that transitions members receiving infusions in outpatient hospital settings to lower-cost alternatives such as home infusion or ambulatory infusion suites. Providers will be contacted beginning in September 2026 to select preferred sites of care for individual members. The practice should prepare to refer eligible patients to in-network, lower-cost infusion sites and engage with Ambetter's care coordination team for referral and coverage assistance.
Get alerts when payers change rules like this one
We check Ambetter and other payers every day and email you when a change matches your specialty and state.
Get Ambetter alertsPolicy Monitoring is free. No card required.
What to do
by Jan 1, 2027 · 6 steps
01Providers should review which members currently receive infusions in outpatient hospital settings and prepare to accept outreach from Ambetter (via fax or phone call beginning September 2026) requesting preferred site-of-care selections for those members.
02Update referral practices so that providers refer eligible patients to in-network, lower-cost infusion sites (home infusion or ambulatory infusion suites) when clinically appropriate.
03Tell providers and clinical staff about the program, emphasizing that Ambetter will support identification of qualified alternative sites and referral facilitation.
04Front desk and scheduling staff should be aware that members may be transitioned to alternative sites and should direct questions about coverage or eligibility to Ambetter's care coordination team at (866) 861-6269.
05The billing team should monitor for changes in where infusion claims originate and ensure documentation reflects the site of care.
06No prior authorization requirement is stated; however, the practice should engage with Ambetter's care coordination team regarding coverage considerations for members being transitioned to alternative sites.
Original notice
Implementation of Site of Care Optimization Program for Ambetter Health Members
ambetterhealth.com · Always check the source before changing claims.