Reminder: Use Paid-through Dates to Verify Member Eligibility

Fecha: 28/05/26

Verifying member eligibility is more important than ever as members are being affected by Marketplace changes.

Members enrolled in a Marketplace health plan are responsible for completing their premium payments each month. Members that do not make their premium payments in a timely manner enter a Grace Period, which begins with the first month a payment is missed and generally continues for 90 days when a member is receiving a premium subsidy.

When a member does not pay all outstanding premiums within the grace period, coverage may be retroactively terminated to an earlier date, and previous claims may be denied. Providers are encouraged to proactively confirm an Ambetter Health member’s status on the date of service or as close to the date of service as possible. Click here to review step-by-step instructions on confirming a member’s eligibility status.

Please keep in mind the various status reasons in the Centene Provider portal and Availity.

• Active: The member is in good standing and has paid premiums in full.
• Active – Pending Investigation (Availity Only): The member is behind in paying the premium.
• Delinquent (non-Availity Secure Portals Only): The member is behind in paying the premium and the Claims Paid Through Date is in the future.
• Suspended (non-Availity Secure Portals Only): The member is behind in paying the premium and the Claims Paid Through Date is in the past.
• Inactive: The member is ineligible, and coverage has been terminated.

Verifying member eligibility helps reduce denied claims, minimizes the administrative burden on your staff, and clarifies when payment may be collected from the member in advance of services. When checking eligibility, please be sure to verify the member eligibility status, the premium paid through date, and the claims paid through date.