How to Submit a Superbill to Centene Corporation for Therapy Reimbursement

Centene Out-of-Network Process

Centene operates multiple health plan brands (including Ambetter, WellCare, and Sunshine Health) and primarily serves Medicaid and Marketplace members. OON coverage is very limited across Centene subsidiaries. Members on applicable plans can submit OON claims through the specific subsidiary's member portal or by mailing a completed claim form with the attached superbill to the subsidiary's OON claims address.

Common Denial Reasons

• ✗Claim submitted to the parent company rather than the correct subsidiary plan
• ✗Member's Medicaid plan has no OON mental health benefit
• ✗Service not covered under the plan's essential mental health benefit package
• ✗Missing prior authorization number on the submitted claim

Tips for Getting Reimbursed by Centene

• ✓Identify which Centene subsidiary the client belongs to (Ambetter, WellCare, etc.) before submitting any claims
• ✓WellCare Medicare Advantage plans may have OON mental health benefits — verify plan details
• ✓Clients should request the OON benefits summary page from their plan documents to confirm coverage
• ✓For Marketplace plans, the OON claim form can typically be found by logging into the subsidiary's member portal