Carelon resources for providersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. Click the links to access more information about these programs, including services that need prior authorization and members. Use AIM’s secure website to submit prior authorization requests for these services that our members may need. If you have questions, call Carelon at 86. Our vendor, AIM Specialty Health administers prior authorization programs for us in the areas listed below. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. our existing process to separate the sessions and make them more specific to specialty types. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. Sunshine Health offers free online accounts for providers. Prior authorization isn't required for the following: There will be no changes to the way providers submit requests or the contact information to check status. To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. AIM Specialty Health (AIM) changed its name to Carelon Medical Benefits Management on March 1, 2023. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines.The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Healthy Blue is contracted with CVS Specialty as a medical specialty pharmacy (MSP). Prior authorization is based on member benefits and eligibility at the time of service. The Availity Portal offers health care professionals free access to. Providers must make prior authorization requests through Carelon for members on plans that require it. Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. ![]() Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross. AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023.
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