Centene Corporation — Ambetter

Standard filing limit

180 days

Counted from

date of service

Appeal filing limit

180 days

Appeal window from

eob date

Notes

Ambetter timely filing: 180 days from date of service in most states (official provider toolkit; state windows vary, e.g. SC 120 days). Appeals: 180 days from the date of the Notice of Adverse Benefit Determination (NABD).

Provider portal

https://www.ambetterhealth.com/en/wa/provider-resources/ ↗ (opens in a new tab)Copy●Verified · August 2026Verified Aug 18, 2026 · Official web pageView source ↗ (opens in a new tab)

Ambetter state provider-resources pages — secure portal, claims, eligibility and prior-authorization tools.

Every contact is individually source-tracked and shows the date it was last verified. A green “Verified” badge only appears when a source and verification date exist.

Authorization

Not yet published for this entry. Prior authorization requirements, channels and retro-authorization rules are published only when verified against a source.

Referrals

Not yet published for this entry. Referral requirements and retro-referral rules are published only when verified against a source.

Appeals

Not yet published for this entry. Appeal levels, filing channels and external-review options are published only when verified against a source.

Medical records

Required

Itemized bill

Not stated

Operative report

Not stated

Other required

Provider Request for Reconsideration and Claim Form

Notes

Provider appeals must include the Provider Request For Reconsideration And Claim Form plus medical records specific to the member's health — including but not limited to MD notes, lab/imaging results and specialty consults for all dates of service in question — submitted in chronological order. First-level appeals (reconsideration) must be received within 90 days of the original EOP; second-level (dispute) within 90 days of the first-level denial notice; both are reviewed within 60 days of receipt.

Common CARCs

1972950

Common RARCs

MA119N29N386M25

Top reasons

Precertification / prior authorization / notification absent (CARC 197) — the payer documents authorization requirements for covered services.; Timely filing (CARC 29) — Ambetter documents a 180-day claim-filing window from the date of service in most states (state windows vary) (paired RARC MA119: provider-level adjustment for late claim filing).; Not medically necessary (CARC 50) — Ambetter documents member and provider appeals of medical-necessity decisions to reduce, terminate, suspend or deny services (paired RARCs N386 NCD-based decision, M25 level of service not substantiated, N29 missing documentation).