Ambetter Health Clarification on Ambetter Eligibility Provider Portal Checks

Date: 07/23/25

Important Clarification on Ambetter Eligibility:

When checking member eligibility, in the Ambetter section of the provider portal please note that if you see "CMS" listed in the Product Name field, this does not indicate that the member is part of the Children’s Medical Services (CMS) line of business.

Instead, "CMS" in this context refers to the ACA/Marketplace line of business offered by Ambetter Health. We understand this label may be confusing, and we are working to improve clarity in the system. In the meantime, please proceed with treating these members as Ambetter members.

If you have any questions or need further clarification, please reach out to your provider engagement team. Navigate to https://www.sunshinehealth.com/providers/pea.html if you need help locating yours.

Thank you for your continued partnership and commitment to our members’ care.