Carelon medical benefits management. Providers: Find important information for you here. Carelon medical benefits management

Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence. Tissue-based somatic genetic testing is considered. m. 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. 1 Last Review Date: 08/31/202124/7 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 genetic counseling providers; Assurance that your practice is providing evidence-based care;If you have questions about your health plan, you can call the number on the back of your 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. On January 1, 2024, CareMore Health and Aspire Health will become Carelon Health. 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. 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. Please consult the applicable health plan for more details. Approval and implementation dates for specific health plans may vary. Action. Link to PDF. For interpretation of the Guidelines, and where not otherwise noted, “adult” refers to persons age 19 and older, and “pediatric” refers to persons age 18 and younger. 1* Carelon ’s medical necessity guidelines are consistent with the clinical appropriateness criteria based on technology assessment, peer-reviewed medical literature including clinical outcomes research and consensus opinion in medical practice. 3K followers 500+ connections See your mutual connections. Approval and implementation dates for specific health plans may vary. Applicable federal and state coverage mandates take precedence over these clinical guidelines. CarelonRx. Ordering providers will be required to obtain prior authorization. Status: Revised Effective Date: 09/11/2022. Effective Date. BCBSMT contracts with outside vendors, including Carelon Medical Benefits Management® (Carelon), eviCore® healthcare and Magellan Healthcare for certain prior authorization services. Carelon Clinical Appropriateness Guidelines for. Doc ID: MSK05-0424. Doc ID: SUR02-0124. Business hours: 8:00 am – 5:00 pm CST. carelon. Included are guidelines for. Pathways are developed using a rigorous process of evidence-based medicine. Link to PDF. Applicable federal and state coverage mandates take precedence over these clinical. Learn how to drive savings, improve experience,. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. Business hours: 8:00 am – 5:00 pm CST. Doc ID: MSK05-0424. Link to PDF. Doc ID: GEN06-0223. Together, Anthem Blue Cross and Blue Shield and Carelon Medical Benefits Management have developed the following programs to support your efforts, and to reduce. Our health plans may use guidelines developed by Carelon Medical Benefits Management, Inc. Carelon Medical Benefits Management supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty benefits management. Please consult the applicable health plan for more details. Providers. Search for: Sleep Disorder Management 2023-09-10. The guidelines do not address coverage, benefit or other plan specific. 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. Link to PDF. That’s why we follow federal civil rights laws in our activities. , S. Carelon Medical Benefits Management* Our health plans may use guidelines developed by Carelon Medical Benefits Management, Inc. California. Applicable federal and state coverage mandates take precedence over these clinical guidelines. Jul 8, 2021. 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. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. Discover how our radiation oncology solution. Effective dates are only updated when there is a change to the pathways. Medical benefits management. Carelon, a separate company, collaborates with payors to help improve health care quality and manage costs for some of today’s complex tests and treatments, promoting patient care that’s appropriate, safe, and affordable. Carelon Medical Benefits Management recognizes the key role that you and other providers play in the delivery of care for patients needing sleep testing and therapy. Home. Copyright © 2023 AIM Specialty Health. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Search for: SPECT Imaging 2023-09-10. This guideline addresses surgery for hallux rigidus when performed as an elective, non-emergent procedure. The volume of data available to health plans today is greater than ever before. Link to PDF. One that sees how data can intervene at just the right time to improve health outcomes. 1-v3 Last Review Date: 11/11/2021 Approval and implementation dates for specific health plans may vary. Clinical criteria for drugs and biologics paid under the medical benefit for certain Medicare/Medicaid markets can be found on the CarelonRx website. Chief Medical Officer Carelon Medical Benefits Management and Carelon Post Acute Solutions Raleigh-Durham-Chapel Hill Area. Carelon Medical Benefits Management Guidelines. Clinical Appropriateness Guidelines for medical necessity/clinical appropriateness reviews for requested interventions for Healthy Blue: . Clinical Appropriateness Guidelines. Please consult the applicable health plan for more details. For questions related to a clinical request, contact Carelon Medical Benefits Management at 866-789-1456 for further assistance. Status: Revised Effective Date: 09/11/2022. 9 New and Emerging Interventions 2021-01-01. Adult seizures. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. CLINICAL APPROPRIATENESS GUIDELINES ADVANCED IMAGINGThe foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. , a specialty health benefits company, will expand multiple programs to perform medical necessity reviews for additional procedures for Anthem Blue Cross and Blue Shield (Anthem) members as further outlined below. Carelon Contact Center Phone. Doc ID: REH02-1223. Link to PDF. The Guidelines do not address coverage, benefit or other plan specific issues. Carelon brings together many of their healthcare solutions offered through Horizon to help support the overall value we bring to our National Account clients. Site of Care for Advanced Imaging 2023-07-01. The individual is a candidate for treatment for elacestrant per the FDA label. Link to PDF. Carelon Medical Benefits Management (formerly AIM Specialty Health) boasts a collaborative, innovative, impact-driven culture. Kidney cancer. Understand the ways medical oncology solutions from Carelon Insights can improve cancer care and its affordability for your health plan members. Added language in the Description and Application of the Guidelines requiring use of FDA approved drugs, radiotracers, and devices in any intervention. One that sees the big picture when it comes to all the factors that influence an individual’s whole health. For general information about Carelon, call 1-847-564-8500, weekdays, from 9 a. 9 Solutions: Cardiology. 2 Last Review Date: 07/18/2023. Carelon Medical Benefits Management Guidelines. 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. PUBLICATIONS: March 2023 Anthem Provider News - Kentucky. 9 Current. If you have questions, please contact your group administrator or your Anthem network representative. 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. Senior Account Management Executive at Carelon Medical Benefits Management Carol Stream, IL. ARCHIVED Arterial Ultrasound 2019-06-29 to 2019-11-09. With over 5 million members supported through this portal, AIM Provider Portal is an effective way to manage patient care costs. Effective 8/01/2023, Anthem providers requesting services for Cardiac Resynchronization Therapy, Cardiac Defibrillators and Peripheral Revascularization for. It’s what we do. It is for historical information only and should not be consulted for clinical use. Doc ID: RBM14-0723. 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, Inc. Our leadership. Technology Considerations. State. m. The Guidelines and Pathways are designed to evaluate and direct the appropriate utilization of certain health care services. Learn how the home-based post-acute care solution from Carelon Insights improves the quality and costs of home care with evidence and provider collaboration. 9 Current. 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. The Carelon Medical Benefits Management Musculoskeletal Program is here to support you in helping your patients receive the care that is appropriate, safe, and affordable. With that in mind, Carelon’s sleep solution offers management of obstructive sleep apnea from diagnosis to treatment options. Carelon Medical Benefits Management. 2 Last Review Date: 05/09/2022 Approval and implementation dates for specific health plans may vary. This rating has been stable over the past 12 months. Following this change, Blue Cross and Blue Shield of Illinois (BCBSIL) will be making updates on our website to our utilization management page and related resources. Developed in collaboration with your patients’ health plans, our Radiation Oncology program helps support quality care that is consistent with current medical evidence. Status: Created Effective Date: 12/30/2023. Carelon Clinical Appropriateness Guidelines for Radiology are developed through a rigorous process integrating evidence-based literature with expert physician review. Explore the ways our surgical procedures solution optimizes surgical care for your health plan members and savings for your health plan. Please consult the applicable health plan for more details. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. For questions about a request or portal support: Call 1-844-411-9622 or contact our support team. 9 Current. Status: Revised Effective Date: 03/17/2024 Doc ID: CAR05-0324. In collaboration with your patients’ health plan, we are implementing a Medical Oncology Program on behalf of Blue Cross NC (BCNC). m. 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. Home. 1 Last Review Date: 09/21/2022. Link to PDF. The. Learn more about the provider resources available to help your healthcare organization manage care and cost and improve patient outcomes. 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. Archive Date: 09/10/2023. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. 1, 2023, AIM will sunset the use of its name and begin operating under a new name, Carelon Medical Benefits Management. 9 Current. Carelon is a healthcare services company dedicated to making it easier to deliver whole-person health. Richard Balow, RPh. Please consult the applicable health plan for more details. Included are guidelines for advanced imaging and nuclear medicine imaging. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Link to PDF. Our name is the only thing that’s changing. Together, Anthem Blue Cross and Blue Shield and Carelon Medical Benefits Management have developed the following programs to support your efforts, and to. Search for: Musculoskeletal. Meet the Carelon leadership team – a passionate group of executives committed to solving healthcare’s most complex challenges. 9 Low-field MRI 2021-01-01. Pharmaceuticals,. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. CarelonRx is an independent company providing pharmacy benefit management services on behalf of the plan. Carelon Medical Benefits Management (formerly AIM Specialty Health) is a company that manages prior authorization for select services for Premera Blue Cross providers. The guidelines do not address coverage, benefit or other plan specific issues. Carelon Health. 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”). Revised 01/24/2023 03/01/2023 Independent Multispecialty Physician Panel (IMPP) review. Repeated diagnostic testing of the same individual and the same tumor by different providers over a short period of time. Please consult the applicable health plan for more details. 9 Imaging of the Chest 2023-04-09. Providers must make prior authorization. Approval and implementation dates for specific health plans may vary. Review – We evaluate your request with regards to: . 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. Doc ID: CAR08-1023. Prior authorization is required for certain procedures and services. Home. The Surgical Procedures review is administered by Carelon Medical Benefits Management on behalf of your patients’ health plan. Effective August 1, 2023, Carelon Medical Benefits Management, Inc. Carelon Medical Benefits Management. Benefits Management (Carelon). Healthy Blue is a Medicaid product offered by Missouri Care, Inc. Joint Surgery 2023-11-05. Carelon is a healthcare services company that connects the healthcare system in powerful ways to remove whole-health barriers and improve outcomes. 01.