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Reminder: Ambetter Health Solutions Providers Must Verify Solutions Eligibility

Date: 05/26/26

Ambetter Health reminds providers that if they are not a part of the Ambetter Health Solutions (ICHRA: Individual Coverage Health Reimbursement Arrangement) network, then they should not render services to Solutions members.

Doing so will result in those claims being denied, or the provider receiving reduced reimbursement.

Ambetter Health Solutions is a Separate Network

Ambetter Health Solutions is an  off-exchange marketplace network and is not interchangeable with the Ambetter Health Core, Premier, or Value networks.

Before treating an Ambetter Health Solutions member, providers must verify two things:

  • Verify that they are participating in the Solutions network
  • Verify that the patient is an eligible member of the Solutions network

Verifying Member Eligibility

Here’s how providers can verify that a member is eligible to receive services:

How to Prevent Denials

  • Submit claims consistent with your contracted arrangement
  • Use the correct Billing (Group) National Provider Identifier (NPI) when contracted at the group level
  • Verify member network and plan type at the time of services
  •  Review the Ambetter Provider Health Manual for billing guidance

Questions?

Ambetter Health has a wealth of resources available to help answer your questions and address your concerns:

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