Please contact Carelon Medical Benefits Management at (800) 252-2021 to obtain general information about Carelon Medical Benefits Management and its services. TDD/TTY services are available for the deaf, hard of hearing or speech-impaired by calling (866) 766-0246 or (877) 201-4508.
Please contact Carelon Medical Benefits Management at (800) 252-2021 to find out how to initiate a request and to be connected with the applicable Carelon Medical Benefits Management toll free number. You may also initiate requests online. Click here to begin the process.
The lists differ depending on the health plan. You should have received a list of CPT codes in the mail from the health plan, along with a detailed description of the utilization review process. If you have additional questions regarding this process or would like a list of services covered by Carelon Medical Benefits Management’s program, please contact Carelon Medical Benefits Management at (800) 252-2021.
Cases are referred for additional clinical review when insufficient information is provided during the initial call. At a minimum, please be prepared to provide the following detailed information:
- Member Demographics (Name, DOB, Health Plan Name, ID#)
- Ordering Provider Demographics (Name, Location or Tax ID#)
- Servicing Provider Demographics (Name, Location, or Tax ID#)
- Service Requested
- Diagnosis
- Additional clinical information, such as duration of symptoms, prior test results, prior applicable personal and/or family medical history, or prior treatment type and duration.
Requests can be initiated at any time using Carelon Medical Benefits Management's Provider Portal. You can also call the specific Carelon Medical Benefits Management toll-free number assigned to the applicable health plan, where you can leave a voicemail after business hours that will be returned the next business day.
Order numbers for utilization review requests that have been processed can be verified online or by calling Carelon Medical Benefits Management at (800) 252-2021. Click here if you would like to verify order numbers online.
Medical offices can initiate utilization review requests online. Click here if you would like to learn more about Carelon Medical Benefits Management’s Provider Portal.
First check the member’s health plan ID card to see if the member’s health plan product participates with Carelon Medical Benefits Management. Once that has been confirmed, you can verify a member’s eligibility online or by calling Carelon Medical Benefits Management at (800) 252-2021.
Carelon Medical Benefits Management’s clinical guidelines are available on its website at https://guidelines.carelonmedicalbenefitsmanagement.com. A request for a copy of criteria can also be made by calling Carelon Medical Benefits Management at (800) 252-2021.
If you would like to voice dissatisfaction with an aspect of Carelon Medical Benefits Management’s services, you may file a complaint by contacting Carelon Medical Benefits Management at (800) 252-2021. You may also call the health plan to lodge a complaint, but Carelon Medical Benefits Management would like to be provided an opportunity to clarify or correct any issue that you may have.
