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AmbetterExchange · Administrative · Marketplace · NVMedium impact

Reminder: Use Paid-through Dates to Verify Member Eligibility

Effective date
Not stated in the notice
Identified
Nov 7, 2026

Summary

Published May 2026: Ambetter Health reminded providers to verify member eligibility by checking the eligibility status, premium paid-through date and claims paid-through date before or near the date of service, because Marketplace members who miss premium payments enter a grace period (generally 90 days for subsidized members) and coverage may be retroactively terminated, which can lead to previously paid claims being denied. Billing staff should confirm each member's status in the Centene provider portal or Availity and interpret the status reasons (Active, Active – Pending Investigation, Delinquent, Suspended, Inactive) before billing.

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What to do

Action · 4 steps
01Ongoing, from publication (May 2026): Billing team should verify each Ambetter Health Marketplace member's eligibility on the date of service, or as close to it as possible, in the Centene provider portal or Availity, checking the eligibility status, the premium paid-through date and the claims paid-through date.
02Front desk staff should run this check at scheduling and check-in, and billing should re-check before claim submission for members whose status is Delinquent or Suspended, or whose paid-through date is near or past.
03Where a retroactive termination is possible, hold or review claims for those members, and if a member's status changes, add a note to the account and follow up with the member on payment status.
04Use the verification results to decide when a member can be billed in advance of services, as the source notes this clarifies when payment may be collected from the member.

Original notice

Reminder: Use Paid-through Dates to Verify Member Eligibility
ambetterhealth.com · Always check the source before changing claims.
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