Carelon medical benefits management. Contributor. Carelon medical benefits management

Visit our site frequently to learn about the best ways to use the Carelon Medical Benefits Management (MBM) provider portal, and how to reduce unnecessary calls by using all available features. The Carelon Medical Benefits Management Clinical Guidelines are based on peer-reviewed literature and recommendations from evidence-based research centers such as (but not limited to): The American College of Medical Genetics (ACMG), The American College of Obstetrics and Gynecologists (ACOG), the AmericanMedical Benefits Management: Specialty Care Tools (formerly offered through AIM Specialty Health) Provider Portal Clinical Guidelines and Pathways Back. And that’s good news for. Status: Revised Effective Date: 03/17/2024 Doc ID: CAR08-0324. Business hours: 8:00 am – 5:00 pm CST. Status: Revised Effective Date: 04/09/2023Who is Carelon Medical Benefits Management? How will the program be administered? Carelon is a leading specialty benefits management company with more than 25 years of experience and a growing presence in the management of radiology, cardiology, genetic testing, oncology, musculoskeletal, sleep management, surgical, and rehabilitation. Participating is most easily managed using the Carelon provider portal, available 24 hours a day, 7 days a week. Status: Revised Effective Date: 09/10/2023 . 9 Current. Eastern time. Learn how Carelon offers. Carelon Clinical Appropriateness Guidelines for Sleep Disorder Management are developed through a rigorous process integrating evidence-based literature with expert physician review. Chromosomal Microarray Analysis 2023-02-12. Carelon Medical Benefits Management provider portal registration. From March 1, 2023, AIM Specialty Health is now Carelon Medical Benefits Management. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Our programs and services benefit:Link to PDF. Current versions of guidelines are available on the Carelon Medical Benefits Management website at. Doc ID: GEN03-0324. We are committed to giving you the tools, knowledge, and resources to. Enter the Tax ID numbers for your providers. Carelon will continue to help manage certain services received by. Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence. Our order request checklist shows exactly what information you’ll need. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Please consult the applicable health plan for more details. Zoom 100%. Approval and. Adult seizures. 9 Spine Surgery 2023-09-10. Pharmaceuticals, radiotracers, or medical devices used in any of the diagnostic or therapeutic interventions listed in the Guidelines must be FDA approved or conditionally approved for the intended use. * (then, AIM Specialty Health ®), would expand the Musculoskeletal Program for Anthem Blue Cross and Blue Shield (Anthem) fully insured members and select members who are covered under self-insured (ASO). 9 Current. Providers may enter cancer treatment drugs, including supportive care drugs, into the ProviderPortal. Together, Anthem Blue Cross and Blue Shield and Carelon Medical Benefits Management have developed the following programs to support your efforts, and to reduce. With our medical benefits management solutions, we optimize your members’ specialty and post acute care, and guide care to the right place, including the home. Send an email. Put the Carelon Medical Benefits Management provider portal to Work for You. Bilateral or multifocal renal tumors. Are you a health plan member? If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card. Title: Microsoft Word - PRV20245-2203-Genetic-Testing-FAQ-PQ-Updated-03022022-BCBS-AL. Search for:. Carelon Contact Center Phone. Carelon Medical Benefits Management, Inc. Contact Center toll-free number at 877‑430-2288, Monday through Friday, 8 a. Business hours: 8:00 am – 5:00 pm CST. 1 Last Review Date: 05/09/2022carelon. For procedures scheduled to begin on or after April 1, 2024, care providers must contact Carelon Medical Benefits Management to obtain PA for the below non-emergency modalities. This rating has been stable over the past 12 months. Any existing authorizations will be honored for the current timeframes, and this change will only apply going forward and reflected in the Carelon Medical Benefits Management (Carelon, formerly AIM Specialty Health) authorization approval. Home. Drug lists, clinical programs, and specialty pharmacy solutions supported by robust clinical expertise. Home. Developed in collaboration with your patients’ health plans, our Cardiology program helps support quality care that is consistent with established best practices. Interventional Pain Management 2023-04-09. Status: Updated Effective Date: 01/01/2024 Doc ID: GEN08-0124. Applicable federal and state coverage mandates take precedence over these clinical guidelines. Please consult the applicable health plan for more details. com Status: Created Effective Date: 02/12/2023 Doc ID: GEN07-0223. We need connected clinical and financial expertise that brings clarity to complex clinical decision-making. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. 1-R0723 Last Review Date: 07/18/2023 Approval and implementation dates for specific health plans may vary. Carelon brings together many of their healthcare solutions offered through Horizon to help support the overall value we bring to our National Account clients. Please consult the applicable health plan for more details. 1 Last Review Date: 04/12/2023. Our advanced analytics, technology, and healthcare IQ make more possible when it comes to driving sustainability. Technology Considerations. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. The Guidelines do not address coverage, benefit or other plan specific issues. Working knowledge of medical terminology required (candidates with at least one year of experience in. 9 Current. Link to PDF. They are. We communicated in the June 2022 edition of the Provider News that Carelon Medical Benefits Management, Inc. Pathway regimens are developed by a dedicated team of pharmacists and medical oncology experts under the oversight of a board. Our clinical staff and approach to care remain the same. If you have questions, call Carelon at 866-666-0776. Carelon Insights offers medical benefits management solutions for health plans that optimize specialty and post acute care, and guide care to the right place, including the. Here’s how to do it: Go to and select “ Register Now ” to launch the registration wizard. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Status: Revised Effective Date: 11/05/2023. Harvard Pilgrim’s Molecular Diagnostic Testing authorization program is managed through an arrangement with Carelon Medical Benefits Management (formerly AIM Specialty Health), and includes the following services: Please submit your authorization request online via Carelon’s portal at or by telephone at 855-574-6476. Call: (800) 252-2021. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Together, our leaders drive the changes that will reduce complexity and make an exponential impact across the health system, from connecting care journeys to making better health more affordable. 2Carelon Medical Benefits Management has developed proprietary Clinical Guidelines and Cancer Treatment Pathways (together with any updates, referred to collectively as the “Guidelines and Pathways”). Kidney cancer. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. Page 1 / 38. 1 Last Review Date: 11/11/2021 Approval and implementation dates for specific health plans may vary. In this free, one-hour webinar for providers, you can: See an overview of Provider Portal, an online tool used to request Carelon clinical reviewOpti Net ®, which is available in the Carelon Medical Benefits Management provider portal, is a proprietary, multifaceted program designed to collect service and capability information on outpatient imaging providers. Doc ID: MSK02-0922. Guidelines for joint surgery, spine surgery, and interventional pain management are included below. Carelon Medical Benefits Management will begin accepting PA requests on March 18, 2024, for dates of service April 1, 2024 and after. Carelon Cancer Treatment Pathways are developed by Carelon oncologists and pharmacists in consultation with a panel of academic and community-based oncologists. The last reviewed dates on the Carelon Medical Benefits Management worksheets coincide with their last review, which varies among worksheets. Please consult the applicable health plan for more details. And that’s good news for your. “Our solution uses a primacy-rules engine and select eligibility details. 8) Note: To prevent delay in processing your request, fill out this form in its entirety with all applicable information. Added language in the Description and Application of the Guidelines requiring use of FDA approved drugs, radiotracers, and devices in any intervention. Wednesday December 6, 2023 @2:00PM CST Click to RegisterWe are here to help you solve your healthcare benefits management challenges. Link to PDF. Carelon Clinical Appropriateness Guidelines for Radiation Oncology are developed through a rigorous process integrating evidence-based literature with expert physician review. Search for: Cardiology. The. At Carelon Medical Benefits Management, we understand emerging science and real-world clinical practice and apply what’s been proven effective to benefit health plan. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. ARCHIVED Arterial Ultrasound 2019-03-09 to 2019-06-28. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Pharmaceuticals, radiotracers, or medical devices used in any of the diagnostic or therapeutic interventions listed in the Guidelines must be FDA approved or conditionally approved for the intended. . Please consult the applicable health plan for more details. Explore the ways our surgical procedures solution optimizes surgical care for your health plan members and savings for your health plan. Contracted providers are financially liable for providing services that are medically unnecessary. Clinical Appropriateness Guidelines. Effective Date. 1 Last Review Date: 05/11/2020 Approval and implementation dates for specific health plans may vary. Approval and implementation dates for specific health plans may vary. Imagining a better healthcare system requires a new perspective. If you’re a health plan member and have a question about your health plan, please call the member services number on the back of your health plan ID card. If you have questions about who to contact for the pre-service review of anticipated services, check the member's ID card or call Carelon at 1-866-766-0250. For questions about the provider network: Call 1-833-585-6262 or email our network team. Please consult the applicable health plan for more details. to 6 p. Specific benefits may vary by product and/or. Link to PDF. State. CLINICAL APPROPRIATENESS GUIDELINES ADVANCED IMAGINGThe foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. The expansion. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. View all Elevance Health jobs in Chicago, IL - Chicago jobs - Director of Product Management jobs in Chicago, ILCarelon Medical Benefits Management Cancer Treatment Pathways. 1 Last Review Date: 07/08/2020Provider inquiries. com Status: Revised Effective Date: 04/09/2023 Doc ID: CAR01-0423. m. Interventional Pain Management 2024-04-14. CarelonRx, Inc. 9 Current. Applicable federal and state coverage mandates take precedence over these clinical guidelines. 1 Last Review Date: 05/09/2022Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Overview. For questions about a request or portal support: Call 1-844-411-9622 or contact our support team. 2 Last Review Date: 07/18/2023. Status: Revised Effective Date: 11/05/2023 Doc ID: MSK02-1123. Effective for dates of service on and after November 5, 2023, the following updates will apply to the Carelon Medical Benefits Management, Inc. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Dr. 3K followers 500+ connections See your mutual connections. Program designs vary by health plan. Effective August 1, 2023, Carelon Medical Benefits Management, Inc. Click on the link to confirm email. Please consult the applicable health plan for more details. 1 Last Review Date: 08/29/2022. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. Search for: Imaging of the Spine 2023-09-10. Search for: Therapeutic Radiopharmaceuticals 2022-11-06. Carelon Medical Benefits Management recognizes the key role that you and other medical practices play in the delivery of care for patients. 2. It is for historical information only and should not be consulted for clinical use. 2K followers 500+ connections See your mutual connections. At Carelon Medical Benefits Management, we understand emerging science and real-world clinical practice and apply what’s been proven effective to benefit health plan members. As communicated in the April Provider Newsletter, effective August 1, 2023, Carelon Medical Benefits Management, Inc. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Pharmaceuticals, radiotracers, or medical devices used in any of the diagnostic or therapeutic interventions listed in the Guidelines must be FDA approved or conditionally approved for the intended use. Richard Balow, RPh. Imagine integrity across every healthcare journey. For questions about the provider network: Call 1-833-585-6262 or email our network team. The lifetime risk of developing a seizure can be as high 8%-10% in the general population with 0. We don’t discriminate, exclude people, or treat them differently on the basis of. Link to PDF. 1-v3 Last Review Date: 11/11/2021 Approval and implementation dates for specific health plans may vary. Approval and implementation dates for specific health plans may vary. Carelon Medical Benefits Management is also available to help you get started for program participation and answer any questions you may have along the way. Carelon Health. 24/7 online access to the Carelon Medical Benefits Management provider portal, a proven technology platform to process reviews in real time; When requested, Carelon can provide access to a database of providers who can perform the genetic counseling; Assurance that your practice is providing evidence-based careCarelon Medical Benefits Management (Carelon) is continually looking for ways to enhance the provider experience by ensuring an efficient order request entry and adjudication process. United States AIM Specialty Health 8 years 1 month Operations Expert. CLICK HERE TO ACCESS PDF VERSION. Include ALL clinical information and other supporting documentation with this form to support each HCPCS requested. Carelon Provider Microsites. There are several different dates that may be associated with a medical policy or clinical utilization management guideline. Effective 8/01/2023, Anthem providers requesting services for Cardiac Resynchronization Therapy, Cardiac Defibrillators and Peripheral Revascularization for. Zoom 100%. Our leadership. Approval and implementation dates for specific health plans may vary. Archive Date: 09/10/2023. Please consult the applicable health plan for more details. Home. Carelon provides delegated benefit management. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Sacroiliac Joint Fusion 2024-04-14. Search for: Low-field MRI 2021-01-01. ARCHIVED Sleep Disorder Management 2019-06-29 to 2020-02-08. Carelon is a healthcare services company dedicated to making it easier to deliver whole-person health. Link to PDF. Included are guidelines for imaging of the heart, diagnostic. Prior authorization is required for certain procedures and services.