Ambetter Texas provider portal, phone and payer ID quick facts
| Provider resource entry point | https://www.ambetterhealth.com/en/tx/provider-resources/manuals-and-forms/ |
|---|---|
| Payer contact reference | 1-877-687-1196 |
| Claims payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Ambetter Texas. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| Timely filing | Texas initial claims: 95 calendar days; other clocks differ |
| Prior auth route | Verify the current product policy and delegated reviewer; X12 278 support is not established by a portal link |
| Last reviewed | 2026-04-23 |
- This registry has not established a payer-specific appeal ladder for Ambetter Texas. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
- This registry has not established one national ERA payer ID for Ambetter Texas. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.
Ambetter Texas at a glance
| Legal name | Ambetter from Superior HealthPlan (TX) |
|---|---|
| Also known as | Ambetter TX, Ambetter from Superior HealthPlan |
| Category | Commercial |
| Parent organization | Centene Corporation |
| Claims payer ID | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| Eligibility (270/271) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| ERA (835) payer ID | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Ambetter Texas. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
| NAIC company code | Not established in this registry |
| States covered | Texas |
| Provider resource entry point | https://www.ambetterhealth.com/en/tx/provider-resources/manuals-and-forms/ |
| Provider phone | 1-877-687-1196 |
Always verify claims-routing details against the member ID card and the payer's current EDI companion guide before submission.
Timely filing & appeals for Ambetter Texas
The 2026 Texas table uses 95 calendar days for participating/non-participating initial claims, measured to receipt from service or the applicable EOP; observation/inpatient uses discharge. COB uses 95 days from the primary payer EOP. Reconsideration/dispute uses 120 days from Ambetter EOP, not service.
| Submission type | Window |
|---|---|
| Initial claim reference | Texas initial claims: 95 calendar days; other clocks differ |
| Out-of-network initial claim | Verify the member's plan and applicable out-of-network rules |
| Secondary / coordination of benefits | Verify the allowed window and start event; a primary EOB does not automatically restart filing |
| Corrected claim | Verify correction instructions; do not substitute an appeal deadline |
| Reconsideration / appeal | Use the applicable denial or decision notice and the process below |
This registry has not established a payer-specific appeal ladder for Ambetter Texas. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
Source: Ambetter Texas provider policy. Always confirm before disputing a TFL denial — payer policies are versioned and product-specific.
Prior authorization with Ambetter Texas
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
CMS-0057-F decision-timeframe requirements and exclusions
Verify Ambetter Texas electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable. Authorization requirements and submission channels depend on the product, service and delegated reviewer. Verify the applicable policy before scheduling; a portal listing is not proof of X12 278 connectivity.
This registry does not provide a current prior-authorization code list for Ambetter Texas. Start with the provider resources or the policy documents below, then confirm the applicable product, service and effective date. A resource link does not establish that a live code-lookup tool is available.
Top denial reasons for Ambetter Texas
Per-payer denial benchmarks publish here once the QuickIntell anonymized ETL pipeline ingests sufficient Ambetter Texas volume. Until then, see the broader CARC reference for industry-wide remediation guides.
Electronic claims, eligibility & ERA
| Transaction | Registry indication — not verification | Routing reference |
|---|---|---|
| 837P / 837I claims | Listed in registry; verify current scope | 68069 — registry reference; verify the member product, transaction and clearinghouse |
| 270 / 271 eligibility | Listed in registry; verify current scope | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately |
| 278 prior authorization | Listed in registry; verify current scope | Verify X12 278 routing separately |
| 835 ERA | Verify support and enrollment separately | No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Ambetter Texas. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment. |
Payer IDs vary by clearinghouse — confirm against your clearinghouse payer list (Availity, Change Healthcare/Optum, Waystar) before configuring submitter routing.
What revenue cycle teams should verify before submitting claims
- This record concerns Texas Ambetter commercial/Marketplace products, not Superior Medicaid. Confirm the exact issuer/product on the member card.
- Claims 68069 is not verification of the eligibility or ERA payer ID. The existing provider/eligibility contact is 1-877-687-1196; follow the relevant service route.
- The manual cover names Celtic Insurance Company EPO, Superior HealthPlan HMO and Ambetter Health of Texas HMO products. Do not collapse the brand into one legal underwriting entity.
Source checks and remaining limits
The latest partial comparison is dated . Retained earlier findings keep their original dates below. This is a partial source check, not a whole-page, clinical or legal review. It does not refresh the legacy review date above.
category, legal issuer scope
Source comparison: 2026-09-18
The checked Texas Ambetter offerings are commercial/Marketplace products, not Superior Medicaid, so the category was corrected. The 2026 manual cover names Celtic Insurance Company EPO, Superior HealthPlan HMO and Ambetter Health of Texas HMO products; no single legal underwriting entity or NAIC was certified. The cover Internal Approved 06262026 is payer-document provenance, not QuickIntell signoff.
Primary source for category, legal issuer scopepayer_ids.claims, provider_phone, portal_url
Source comparison: 2026-09-18
The Texas quick guide supports claims 68069 and the existing 1-877-687-1196 provider/eligibility contact. Only the claims field is populated; that identifier is not evidence for eligibility, ERA or authorization routing. Public resource links are entry points, not authenticated portal tests. Locator: member eligibility, Provider Services and Claims sections.
Primary source for payer_ids.claims, provider_phone, portal_urltimely_filing_days, filing_rule, timely_filing_source_url, appeal scope
Source comparison: 2026-09-18
The 2026 table gives participating/non-participating initial claims 95 calendar days to receipt from service or the applicable EOP; observation/inpatient uses discharge. COB uses 95 days from primary-payer EOP; reconsideration/dispute uses 120 days from Ambetter EOP. These are distinct clocks, not a sequential appeal ladder. Locator: printed page 72/PDF page 73, visually inspected.
Primary source for timely_filing_days, filing_rule, timely_filing_source_url, appeal scopeera_payer_id, electronic transaction scope
Source comparison: 2026-09-18
Printed page 73/PDF page 74 describes 837 submission and 835 generation, but this pass did not establish an ERA or eligibility routing identifier or universal 278 capability. The unresolved ERA source pointer now references that passage instead of the filing table. Claims 68069 is not copied into other transaction fields. PDF page 74 was visually inspected.
Primary source for era_payer_id, electronic transaction scope
Not checked in this pass: Exact legal underwriting entity/NAIC, current enrollment and product-complete geographic coverage unless expressly scoped above; Complete initial, corrected, secondary, appeal and dispute requirements, agreements, delegation exceptions and effective dates; Every eligibility, ERA and authorization identifier and capability; a claims ID or portal does not certify other transactions; Current clinical criteria, prior-authorization code samples and medical decisions; QuickIntell integrations/outcomes and historical April 2026 DataForSEO demand; Accountable whole-record editorial approval; all last_reviewed dates remain unchanged.
State coverage
Ambetter Texas operates in the following states. Each link opens state-level Medicaid program details, dominant commercial payers, and state-specific RCM regulations.
Evaluate QuickIntell workflow fit for Ambetter Texas
These module references are evaluation starting points, not evidence of a validated connection, supported transaction or customer deployment. Confirm the actual member plan, data access and product scope first.
- QuickRCM
Evaluate claim preparation, follow-up and denial worklists for Ambetter Texas; verify the actual plan rules and available connections before implementation.
- QuickAuth
Assess authorization-packet and status workflows for Ambetter Texas; confirm product, service, delegated reviewer and permitted submission channels.
- QuickERA
Verify the actual 835 files, posting exceptions and reconciliation requirements for Ambetter Texas before evaluating automation. An ERA identifier alone does not establish supported ingestion or posting.
Frequently asked questions about Ambetter Texas
Where is the Ambetter Texas provider portal?
Use https://www.ambetterhealth.com/en/tx/provider-resources/manuals-and-forms/ as a starting point for Ambetter Texas provider resources. This link may open a directory or contact page rather than a transaction portal. Select the applicable product and administrator, then verify the available functions, enrollment and access requirements. QuickIntell is not the official payer portal.
What is the timely filing limit for Ambetter Texas?
The 2026 Texas table uses 95 calendar days for participating/non-participating initial claims, measured to receipt from service or the applicable EOP; observation/inpatient uses discharge. COB uses 95 days from the primary payer EOP. Reconsideration/dispute uses 120 days from Ambetter EOP, not service.
What is the Ambetter Texas payer ID?
Claims: 68069 — registry reference; verify the member product, transaction and clearinghouse. Eligibility (270/271): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. ERA (835): No single all-product identifier established in this registry; see source findings and verify the member product and transaction separately. Clearinghouse-specific: This registry has not established one national ERA payer ID for Ambetter Texas. ERA enrollment and 835 routing are clearinghouse- and product-specific; verify in the payer portal or clearinghouse payer list before enrollment.. Do not substitute a claims ID for an unverified transaction ID. Check current source findings and the member ID card before submitting.
Does Ambetter Texas accept electronic claims?
Verify Ambetter Texas electronic claims (837), eligibility (270/271), remittance (835) and authorization (278) separately for the member product and clearinghouse. Registry flags and routing references are not current transaction-complete approval. Confirm the companion guide, enrollment and applicable source findings below. A blank or unverified field does not establish that the transaction is unavailable.
How do I appeal a Ambetter Texas denial?
This registry has not established a payer-specific appeal ladder for Ambetter Texas. Use the denial notice, plan document, provider agreement, or jurisdictional rule to assign the correct route and deadline. Missing registry evidence does not mean appeal rights are unavailable.
How long do Ambetter Texas prior authorization approvals take?
Decision deadlines depend on the product, service and urgency. CMS-0057-F generally starts its decision-timeframe requirements in 2026 for Medicare Advantage, Medicaid and CHIP payers subject to the rule: seven calendar days for standard requests and 72 hours for expedited requests. Those requirements exclude drug authorizations and QHP issuers on the federally facilitated exchanges. Other plans, state rules and permitted extensions can differ. Check the applicable policy; a decision deadline is not a guarantee of approval.
What is the Ambetter Texas provider phone number?
This registry lists 1-877-687-1196 as a contact reference for Ambetter Texas. Confirm the number and service scope against the member ID card and current product-specific directory; claims, eligibility and authorization inquiries may use different teams.
Automate workflows around Ambetter Texas requirements
Connect eligibility, prior authorization, pre-submission claim checks, and remittance routing in one governed workflow. Payer and plan configuration is confirmed during implementation.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. Payer policies change without notice — always verify against Ambetter Texas's current published documents before submission. CPT® is a registered trademark of the American Medical Association.