Ambetter Billing Guide for Therapists and Psychiatrists

Ambetter is the Affordable Care Act (ACA) marketplace brand of Centene Corporation. It sells individual and family plans, and each state runs under its own local plan name. That local name decides where your claim goes and how long you have to file it.

Checked 10/1/26. Marketplace plans change each plan year. Confirm with Ambetter before you rely on a deadline.

Which states does Ambetter serve?

Ambetter lists 29 states for plan year 2026 on its enrollment page and Centene page. Of the ten states MCM South serves, Ambetter sells in Georgia, Texas, Florida, Tennessee, North Carolina, Illinois and New York. Colorado, Massachusetts and Connecticut do not appear on Ambetter's list.

Coming changes. Centene will leave the Delaware and New Hampshire marketplaces at the end of 2026 (Becker's Payer Issues). Neither is a state MCM South serves. Plans can change entity names between plan years, so read Ambetter provider news each fall for payer ID or address changes.

Payer ID and the plans under it

Ambetter's electronic payer ID is 68069 in Georgia, Texas, Florida, Tennessee, North Carolina and Illinois. Each state's provider quick reference guide prints it. New York is different: Ambetter from Fidelis Care uses 11315, not 68069 (Fidelis Care provider page).

Other insurers under the same ID. Ambetter's guides show 68069 only for Ambetter plans. Centene does not publish a list of other brands that share it, and its health plan list carries no payer IDs. Do not assume Centene's Medicaid or Medicare plans use 68069. Ask Centene EDI at or call Availity (1-800-282-4548) if a claim rejects.

Claims address and filing deadlines

Paper claims for Georgia, Texas, Florida, Tennessee, North Carolina and Illinois: Ambetter, Attn: Claims Department, PO Box 5010, Farmington, MO 63640-5010. New York (Fidelis): Fidelis Care, PO Box 724, Amherst, NY 14226-0724. Send electronically through Availity when you can.

Timely filing for a first claim (from each state's quick reference guide, checked 10/1/26):

Florida, North Carolina, Texas and Tennessee guides state one limit. Each state's deadline is different, so never carry one across.

Disputes. Level II claim disputes go to the PO Box 5010 address above in Texas, Florida and Tennessee. North Carolina and Illinois guides send disputes to PO Box 10341, Van Nuys, CA 91410. Deadlines run from the explanation of payment (EOP) date and differ by state. Open the state's Claims, Coding and Utilization guide (example link: Tennessee) before you file.

Provider contacts and state regulators

Behavioral health on Ambetter

• Who manages it. Texas states it directly: Ambetter from Superior HealthPlan manages behavioral health in-house (prior authorization list). The other states' guides route behavioral health through the plan's own medical management. Call Provider Services before you assume a separate vendor.
• Prior authorization. Texas requires it for outpatient therapy, psychological and neuropsychological testing, TMS, ABA and higher levels of care. Submit at least five business days ahead. Other states list their own fax lines in the state guide.
• Credentialing. All states use CAQH ProView, with recredentialing every 36 months. Georgia has a separate behavioral health network request form.
• Telehealth. Florida's Ambetter telemedicine page lists modifier GT with POS 02. Texas posted a June 2025 modifier 95 notice. We found no policy for the other states. Do not carry one state's rule over.
• Psychiatrists. Bill medication management with E/M and add-on codes. See our CPT and E/M code guide.

Marketplace, Medicaid and state law: keep them separate

• Private payer (marketplace). Ambetter is a private insurer selling ACA plans. This page covers those plans only.
• Medicaid and Medicare. Centene runs separate Medicaid and Medicare plans under other names. Their IDs, addresses and deadlines are different. Start at the state Medicaid site, not this page.
• State law. Each state regulator in the table sets rules for fully insured plans. Georgia, Illinois and New York run their own exchanges.

What to do Monday morning

1. Check the plan name on the card: "Ambetter from Peach State" is not "Ambetter Health."
2. Verify eligibility on the first visit. Marketplace members can lose coverage after a grace period, and claims may pend or deny later.
3. Match the payer ID to the state. New York is the exception.
4. Put the state's filing deadline in your tracker. Tennessee's 90 days is the shortest limit that applies to every claim.
5. Look at Ambetter provider news each fall for next year's changes.

How MCM South handles Ambetter billing

MCM South bills Ambetter and other marketplace plans for psychotherapists and psychiatrists. We check benefits and the grace-period status, submit claims electronically, work denials and appeals, and handle credentialing. Get a free quote.

Frequently asked questions

What is the Ambetter payer ID?

It is 68069 in Georgia, Texas, Florida, Tennessee, North Carolina and Illinois. New York's Ambetter from Fidelis Care uses 11315.

How long do I have to file an Ambetter claim?

It depends on the state. Tennessee is 90 days, Texas 95 days, and Florida and North Carolina 180 days. Georgia and Illinois are 180 days in-network and 90 days out-of-network.

Is Ambetter available in Colorado, Massachusetts or Connecticut?

Not on Ambetter's 2026 state list, so a card from those states is not an Ambetter marketplace plan.

Who manages Ambetter behavioral health?

Texas says in-house. For other states, call Provider Services at the number above.

Sources (checked 10/1/26)

Ambetter state quick reference guides and provider manuals; Centene investor releases; Fidelis Care; Becker's Payer Issues; state exchanges and regulators. Links inline.

Related guides: Private Insurances hub · Billing Terms Glossary · Who We Serve · All resources.