Carelon medical benefits management. Carelon is a healthcare services company dedicated to making it easier to deliver whole-person health. Carelon medical benefits management

Physicians and other healthcare providers are at the center of what we do, and we recognize the challenges that you face keeping up with rapidly advancing areas of medicine. “Our solution uses a primacy-rules engine and select eligibility details. Medical benefits management. Technology Considerations. We use our expertise, dedication, and compassion to provide exceptional experiences. Developed in collaboration with your patients’ health plans, our Sleep Program supports providers in helping ensure patients receive sleep management services that are. Enter User Details and select User Role as “ Ordering Provider “. The Carelon Medical Benefits Management provider portal will be unavailable Sundays between 12:30 PM CST - 6:00 PM CST for regularly scheduled maintenance. Call: (800) 252-2021. 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. Carelon is a healthcare services company dedicated to making it easier to deliver whole-person health. 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. Carelon Medical Benefits Management has developed proprietary Clinical Guidelines and Cancer Treatment Pathways (together with any updates, referred to collectively as the “Guidelines and Pathways”). Jul 8, 2021. ARCHIVED Sleep Disorder Management 2019-03-09 to 2019-06-28. CT, Saturdays, Sundays and Holidays, 9 a. Search for: SPECT Imaging 2023-09-10. Home. Insights that optimize specialty and post-acute care, helping to guide care to the right place — whether in the clinic, virtually, or at home. 2-R1220-v2 Last Review Date: 12/03/2020 Approval and implementation dates for specific health plans may vary. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Who 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. Use Carelon’s secure website to submit prior authorization requests for these services that our members may need. Please consult the applicable health plan for more details. is an Active company incorporated on February 19, 1996 with the registered number F96000000820. Home. 1 Last Review Date: 03/25/2019The Surgical Procedures review is administered by Carelon Medical Benefits Management on behalf of your patients’ health plan. 1 Last Review Date: 11/11/2021 Approval and implementation dates for specific health plans may vary. View Cardiology Clinical Guidelines on the Carelon website. The system will thereafter identify cancer treatment regimens that match the list of drugs which have been entered. The use of NGS testing of tumor DNA is considered. Applicable federal and state coverage mandates take precedence over these clinical guidelines. 69716, 69719, 69726, 69727, L8690, L8691, L8692, L8693, L8694. Sign in to the Carelon Provider Portal Provider Portal opens a dialog window‌ and select Diagnostic Imaging. Please consult the applicable health plan for more details. Learn how Carelon offers people-first care models, integrated digital tools, and services for health plans, providers, and individuals with complex needs. There isn’t anything you need to do, because all that’s changing is our name. is an independent company providing utilization management services on behalf of the health plan. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Link to PDF. This transition is a name change only, and there will be no process changes. Carelon offers medical benefits management solutions that optimize your members’ specialty and post acute care, and guide care to the right place, including the home. 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. CLICK HERE TO ACCESS PDF VERSION. It is for historical information only and should not be consulted for clinical use. 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. Home. 9 Current. and practices of the group. Cell-free DNA Testing for Cancer 2024-03-17. What is the relationship between Carelon and the health plan? The health plan has contracted with. Link to PDF. 9 New and Emerging Interventions 2021-01-01. California. Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence. Approval and implementation dates for specific health plans may vary. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. 2 Last Review Date: 07/18/2023. 1-v3 Last Review Date: 11/11/2021. 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 requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Check your inbox for. Developed in. Effective March 1, 2023, AIM Specialty Health ® is changing its name to Carelon Medical Benefits Management. CLICK HERE FOR PDF VERSION. * Carelon Medical Benefits Management, Inc. Please consult the applicable health plan for more details. Carelon Cancer Treatment Pathways are a key component of each program. Applicable federal and state coverage mandates take precedence over these clinical guidelines. Call the Carelon provider portal support team at 800-252-2021 for help using the provider portal. This document has been archived because it has outdated information. Doc ID: MSK05-0124. Once registered, log in to the Carelon Medical Benefits Management provider portal to begin the order entry process. The Guidelines do not address coverage, benefit or other plan specific issues. Status: Revised Effective Date: 04/14/2024. The Guidelines do not address coverage, benefit or other plan specific issues. Medical Benefits Management: Specialty Care Tools (formerly offered through AIM Specialty Health). View all Elevance Health jobs in Chicago, IL - Chicago jobs - Director of Product Management jobs in Chicago, ILCarelon Medical Benefits Management Cancer Treatment Pathways. This guideline addresses surgery for hallux rigidus when performed as an elective, non-emergent procedure. Carelon Clinical Appropriateness Guidelines for Radiology are developed through a rigorous process integrating evidence-based literature with expert physician review. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Services include genetic testing, imaging, radiation oncology, and sleep study. The guidelines do not address coverage, benefit or other plan specific issues. 8) Note: To prevent delay in processing your request, fill out this form in its entirety with all applicable information. Contracted providers are financially liable for providing services that are medically unnecessary. Carelon Medical Benefits Management will begin accepting PA requests on March 18, 2024, for dates of service April 1, 2024 and after. BCBSIL contracts with Prime to provide pharmacy. Offered through Carelon Medical Benefits Management (Formerly AIM Specialty Health) Provider portal Submit a new case for prior authorization, or check on an existing one. 2 Last Review Date: 08/29/2022. Carelon Medical Benefits Management (formerly AIM Specialty Health) Mar 2023 - Present 8 months. AIM Specialty Health and myNEXUS have now adopted the Carelon brand. The most toxic upper management I’ve ever witnessed The benefits are horrible given this is a healthcare benefit organization. Our partners are invested in the local community and committed to developing leaders from within. Carelon Medical Benefits Management (formerly AIM Specialty Health) boasts a collaborative, innovative, impact-driven culture. 1 Last Review Date: 04/12/2023. 1 Last Review Date: 09/21/2022 Approval and implementation dates for specific health plans may vary. Our name is the only thing that’s changing. Providers: Find important information for you here. If you have questions, please contact your group administrator or your Anthem network representative. m. Learn about. , we know that this is challenging work. These Texting Terms and Conditions apply when you provide prior express consent to receive text messages from Carelon businesses, agents, contractors, or vendors ("us" or "we" or "our'). Doc ID: GEN03-0324. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions for Healthy Blue: . Understand how the genetic testing solution from Carelon Insights reduces spending on unnecessary testing and delivers clarity to your health plan members. Business hours: 8:00 am – 5:00 pm CST. 1 Last Review Date: 05/09/2022 Approval and implementation dates for specific health plans may vary. 9 Current. 24/7 phone,. Carelon Medical Benefits Management provides clinical appropriateness guidelines and cancer treatment pathways for various diagnostic and therapeutic interventions. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Approval and implementation dates for specific health plans may vary. Participating in the Program is most easily managed using the Carelon ProviderPortal SM, available 24/7, or by calling Carelon directly. INBCBS-CD-011936-22 March 2023. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Carelon Medical Benefits Management is independent from and not affiliated with Horizon Blue Cross Blue Shield of New. Check system requirements, account status, and security updates before. Applicable federal and state coverage mandates take precedence over these clinical. Bryn Mawr Ave. Our next generation of solutions focus on preventing errors before claims are paid for greater efficiency, better experiences, and improved costs. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Our vision is focused on serving the individual with clinical insights and innovative solutions to meet members wherever they are in their healthcare journey. This rating has been stable over the past 12 months. Applicable federal and state coverage mandates take precedence over these clinical guidelines. Scope. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling Carelon at 844-411-9622 or by email. To view this article online:HOME HEALTH CARE AUTHORIZATION REQUEST FORM PLEASE FAX THIS FORM ALONG WITH REQUIRED INFORMATION TO: 844-834-2908 Questions? Call 844-411-9622 Date of Request: Standard Request: Retro Request: Urgent Request: Note: Expedited organization determinations (urgent requests), can only beCarelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. It’s what we do. The Guidelines do not address coverage, benefit or other plan specific issues. Please consult the applicable health plan for more details. Our goal is to provide tips and tricks to make your day easier and more. Upcoming Provider Q&A Sessions for the Radiology, Cardiology, and Sleep Management programs: Tuesday September 12, 2023 @2:00PM CST Click to Register. 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. The Guidelines and Pathways are designed to evaluate and direct the appropriate utilization of certain health care services. Approval and implementation dates for specific health plans may vary. While the Carelon name means complete care, AIM’s new name will not change the way it works with providers. Learn more about the transition, the effective date, and the impacted services on this. Anatomic coverage for thoracic imaging includes the area between the lung apices and the costophrenic sulci—specifically, the lung parenchyma, pleura, mediastinum, and musculoskeletal structures of the thorax. Disclaimer: Coverage is subject to applicable benefit contract. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Our clinical guidelines and pathways,. Carelon Medical Benefits Management. Our system is designed to help guide your test and laboratory selection, and alert you to any genetic counseling requirements. CLINICAL APPROPRIATENESS GUIDELINES ADVANCED IMAGING Appropriate Use Criteria: Imaging of the Chest Proprietary RBM02-0322. 9 Current. Check with us to find out if your provider has requested prior authorization before you get any services. Home. Guidelines for imaging modalities. Link to PDF. The Guidelines do not address coverage, benefit or other plan specific issues. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. 9 Solutions: Cardiology. Pathways are developed using a rigorous process of evidence-based medicine. Surgical Site of Care 2023-12-30. 9 Imaging of the Head and Neck 2023-04-09. 9 Current. Offered through Carelon Medical Benefits Management (Formerly AIM Specialty Health) Provider portal. This document has been archived because it has outdated information. Carelon is a specialty health benefits company that works with leading insurers to improve health care quality and manage costs for today’s most complex and prevalent clinical guidelines, tests and treatments, helping to promote care that is appropriate, safe and affordable. * (formerly AIM Specialty Health ® [AIM]) will expand multiple Carelon programs to perform medical necessity reviews for additional procedures for Anthem Blue Cross and Blue Shield (Anthem) members. Chief Medical Officer Carelon Medical Benefits Management and Carelon Post Acute Solutions Raleigh-Durham-Chapel Hill Area. ARCHIVED Arterial Ultrasound 2019-06-29 to 2019-11-09. Continuous positive airway pressure (CPAP) devices, bi-level (Bi-PAP) devices, and all supplies. Carelon Medical Benefits Management recognizes the key role that medical practices play in the delivery of care for patients with cardiovascular disease. Rutherford S, Zhang X, Atzinger C, et al. For questions about a request or portal support: Call 1-844-411-9622 or contact our support team. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Online: Log in to the Carelon ProviderPortal Available 24/7/365. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Carelon Medical Benefits Management Guidelines. Medical benefits management: Specialty care. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Our order request checklists show exactly what information you’ll. For questions about the provider network: Call 1-833-585-6262 or email our network team. Applicable federal and. Updated references. 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. carelon. Together they apply a rigorous process to evaluate regimens supported by national guidelines such as NCCN guidelines. Carelon brings together many of their healthcare solutions offered through Horizon to help support the overall value we bring to our National Account clients.