Centene and Ambetter billing and credentialing
Billing for Centene’s health plans, including Ambetter Marketplace plans and Centene’s state Medicaid plans.
Working with Centene and Ambetter
Centene is one of the largest Medicaid and Marketplace insurers in the US. It runs Medicaid plans under local names in many states, Ambetter Marketplace plans and Wellcare Medicare plans.
Plan types we bill:
- Medicaid plans under state-specific names
- Ambetter Marketplace plans
- Wellcare Medicare Advantage
Credentialing and enrollment
For Medicaid products, you must first be enrolled with the state Medicaid agency, then credentialed with the plan.
Credentialing uses your CAQH ProView profile, which must be complete and re-attested every 120 days.
Prepare
Licenses, NPI, CAQH and group details checked and updated.
Apply
Application submitted for each provider and location.
Follow up
Status checked every 1 to 2 weeks until approval.
Confirm
Effective date and participation confirmed before billing.
Claims, eligibility and portals
Each Centene state plan has its own provider portal, policies and payer ID, so we set up billing for the exact plan in your state.
Denials we prevent with Centene and Ambetter
- Provider enrolled with the state but not credentialed with the plan
- Member assigned to a different plan this month
- Missing plan prior authorization
- Behavioral health or vision carved out to another vendor
- State-specific coding or modifier rules not followed
Questions about Centene and Ambetter
Is Ambetter the same as the Medicaid plan in our state?
Both are Centene, but they are separate products with separate rules and sometimes separate networks.
Trademarks belong to their owners. MedAi Billing Solutions is an independent billing company, not affiliated with any payer or government agency.
Get help with Centene and Ambetter claims
Send a few details and we will set up a short call to review your claims, denials and A/R. No cost and no commitment.
We sign a Business Associate Agreement before we handle any patient data.