Carelon medical benefits management. From March 1, 2023, AIM Specialty Health is now Carelon Medical Benefits Management. Carelon medical benefits management

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. 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. 9 Vascular Imaging 2023-09-10. It is for historical information only and should not be consulted for clinical use. The guidelines do not address coverage, benefit or other plan specific issues. CLICK HERE TO ACCESS PDF VERSION. The Guidelines and Pathways are designed to evaluate and direct the appropriate utilization of certain health care services. The Radiation Oncology Program will be administered by Carelon on behalf of your patients’ health plans. Call the Carelon provider portal support team at 800-252-2021 for help using the provider portal. Status: Created Effective Date: 12/30/2023. Carelon Medical Benefits Management, Inc. Provider Portal Clinical Guidelines and Pathways. Status: Revised Effective Date: 04/14/2024. 1 Last Review Date: 05/09/2022 Approval and implementation dates for specific health plans may vary. We encourage you to review the FAQs for each patient’s plan on the Resources page. Approval and implementation dates for specific health plans may vary. Carelon is a healthcare services company dedicated to making it easier to deliver whole-person health. This phone number. Understand how the genetic testing solution from Carelon Insights reduces spending on unnecessary testing and delivers clarity to your health plan members. Genetic Testing Guidelines: Carrier Screening. Find out more about salaries and benefits at Carelon. And that’s good news for. For questions related to a clinical request, contact Carelon Medical Benefits Management at 866-789-1456 for further assistance. If you do not want to be contacted by phone, just let the caller know and we. Please consult the applicable health plan for more details. The lifetime risk of developing a seizure can be as high 8%-10% in the general population with 0. 66: Musculoskeletal Services. Doc ID: RBM06-0423. Search for: Radiology. Please consult the applicable health plan for more details. Included are guidelines for. 3/2023 AIM Specialty Health changed its name to Carelon Medical Benefits Management. Create user name and password. Effective for dates of service on and after November 5, 2023, the following updates will apply to the Carelon Medical Benefits Management, Inc. Carelon Medical Benefits Management (formerly AIM Specialty Health) is an independent company that has contracted with BCBSIL to provide utilization management services for members with coverage through BCBSIL. com Status: Reaffirmed Effective Date: 08/16/2020 Doc ID: SDM01-0820. Status: Created Effective Date: 01/01/2024 . Genetic Testing for Inherited Conditions 2023-02-12. Cancer Treatment Pathways are selected from therapies recommended by national guidelines on the basis of: Clinical benefit (efficacy) Side-effects (toxicity), especially those that lead to hospitalizations or impact quality of life. AIM Specialty Health will transition to Carelon Medical Benefits Management Inc. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Data analytics tools like Carelon’s Coordination of Benefits Consensus solution allow plans to go on the offensive when it comes to payment integrity. Guidelines for radiation therapy, proton beam. Please consult the applicable health plan for more details. Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence. Providers will be asked to submit information in areas such as staffing credentials and certifications for both technologists and physicians. As communicated in the April Provider Newsletter, effective August 1, 2023, Carelon Medical Benefits Management, Inc. Imagine integrity across every healthcare journey. Surgical Site of Care 2023-12-30. 9 Level of Care for Musculoskeletal Surgery 2023-11-05. Home. Medical benefits management. to 6 p. jeopardize the life or health of the member. Developed in collaboration with your patients’ health plans, our Sleep Program supports providers in helping ensure patients receive sleep management services that are. The new name will not impact the way AIM works with health plans. Mental Health and Substance Use Disorder (MH/SUD) Benefits: These are covered through Carelon Behavioral Health. Proton Beam Therapy 2022-03-13. Home. by skozmic | Jun 18, 2023. The Guidelines do not address coverage, benefit or other plan specific issues. Learn more about the transition, the effective date, and the impacted services on this. Please consult the applicable health plan for more details. Carelon Medical Benefits Management recognizes the key role that you and other providers play in the delivery of care for patients needing rehabilitative services to improve, adapt or restore functions, which have been impaired or permanently lost. If you have any questions, please contact Customer Service at 877-275-9787. For questions about a request or the Provider Portal: Call 1-800-252-2021 or contact our support team. Send an email. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. In March 2023, AIM Specialty Health ® * will transition to Carelon Medical Benefits Management Inc. Search for: Joint Surgery 2023-11-05. Link to PDF. Kidney cancer. Link to PDF. Carelon Medical Benefits Management understands the key role that medical practices play in the delivery of care for patients who require imaging studies. The following sleep disorder management medical policies will be retired effective September 1, 2019. Chest imaging studies are not appropriate for cardiac and coronary artery imaging. Enter User Details and select User Role as “ Ordering Provider “. Learn how our radiology solution reduces spending and your plan members' exposure to unnecessary radiation by promoting evidence-based imaging. Home. Our perspective: Insights-driven health outcomes. Link to PDF. 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. Doc ID: GEN09-0223. 1 Last Review Date: 05/09/2022 Approval and implementation dates for specific health plans may vary. People are healthy when they’re healthy in mind, body, and spirit. 2. Find out how the musculoskeletal care solution from Carelon Insights, formerly AIM, ensures high-quality, cost-effective musculoskeletal care for your members. Hallux rigidus is a painful arthritis of the first metatarsophalangeal (MTP) joint, which can cause stiffness and progressive loss of motion. Tissue-based somatic genetic testing is considered. Current General Guideline The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Welcome. CLICK HERE TO ACCESS PDF VERSION. Call 1-844-411-9622 or contact our support team. Search for: Imaging of the Spine 2023-09-10. Carelon collaborates with you to improve health care quality and manage costs for some of today’s complex tests and treatments. 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: 01/24/2023If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Effective March 1, 2023, AIM Specialty Health ® is changing its name to Carelon Medical Benefits Management. Applicable federal and state coverage mandates take precedence over these clinical guidelines. Doc ID: MSK01-0423. Please consult the applicable health plan for more details. Clinical criteria for drugs and biologics paid under the medical benefit for certain Medicare/Medicaid markets can be found on the CarelonRx website. 1 Last Review Date: 09/21/2022. Benefits Management (Carelon). CLICK HERE TO ACCESS PDF VERSION. Status: Created Effective Date: 02/12/2023. The Carelon Medical Benefits Management, Inc. Joint Surgery 2022-09-11 for Iowa and Louisiana Medicaid. Ordering providers will be required to obtain prior authorization. Home. Revised 01/24/2023 03/01/2023 Independent Multispecialty Physician Panel (IMPP) review. The calls may be to let you know about treatment options or other health-related benefits and services. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon Guidelines. Your members may need durable medical equipment, prosthetics, orthotics, or supplies (DMEPOS) after a hospital stay. m. The Guidelines do not address coverage, benefit or other plan specific issues. Please consult the applicable health plan for more details. Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways. Carelon Provider Microsites. Carelon Medical Benefits Management (MBM) helps ensure clinically appropriate care is adopted across today’s most complex, costly, and specialized clinical areas. Meet the Carelon leadership team – a passionate group of executives committed to solving healthcare’s most complex challenges. Approval and. CLICK HERE FOR PDF VERSION. 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”). Approval and implementation dates for specific health plans may vary. Carelon is a leading specialty benefits management company with more than 25 years of experience and a growing presence in the management of cardiology, radiology, genetic testing, oncology, musculoskeletal, sleep management, surgical, and rehabilitation. In CVS Health’s case, executives said the CVS Healthspire brand reflects the “trust, familiarity and community access” of the CVS. Carelon Medical Benefits Management disclaims any responsibility for the completeness or accuracy of the information contained herein. Continuous Improvement Activities Please be aware that Optima Health continues to improve the performance of the integration of ourSleep Disorder Management for Medicare Advantage Products Prior authorization through Carelon Medical Benefits Management is required for Medicare Advantage products. Home. 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. INBCBS-CD-011936-22 March 2023. com Status: Revised Effective Date: 09/11/2022 Doc ID: MSK02-0922. 9 Current. For questions related to a clinical request, contact Carelon Medical Benefits Management at the number on your patient’s health ID card for further assistance. Doc ID: MSK02-1123. Home. 1 Last Review Date: 05/09/2022. Interventional Pain Management 2023-04-09. The guidelines do not address coverage, benefit or other plan specific issues. These guidelines address advanced imaging of the head and neck in both adult and pediatric populations. , 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. Please consult the applicable health plan for more details. CLINICAL APPROPRIATENESS GUIDELINES MUSCULOSKELETAL PROGRAMApproval and implementation dates for specific health plans may vary. It’s important we treat you fairly. Search for: Therapeutic Radiopharmaceuticals 2022-11-06. 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. If the best treatment is. On March 1, 2023, AIM Specialty Health changed its name to Carelon Medical Benefits Management. Pharmaceuticals,. Developed in collaboration with your patients’ health plans, our Radiology program helps support quality care that is consistent with current medical evidence and delivered in the most. 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. Here’s how to do it: Go to and select “ Register Now ” to launch the registration wizard. Search for: MR-guided Procedures 2021-01-01. Status: Created Effective Date: 02/12/2023. The Amerigroup Cancer Care Quality Program will be administered by Carelon Medical Benefits Management on behalf of your patients’ health plans. Check your inbox for an email from Carelon. We need progressive ideas on analytics and technology that help remove friction to drive whole health. Carelon Medical Benefits Management (formerly AIM Specialty Health) Mar 2023 - Present 8 months. Applicable federal and state coverage mandates take precedence over these clinical guidelines. It is for historical information only and should not be consulted for clinical use. The Guidelines do not address coverage, benefit or other plan specific issues. If you have questions, please contact your group administrator or your Anthem network representative. Carelon Medical Benefits Management Clinical Guidelines. For questions about the provider network: Call 1-833-585-6262 or email our network team. com Status: Created Effective Date: 02/12/2023 Doc ID: GEN07-0223. 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. Amerigroup Cancer Care Quality Program. Carelon Medical Benefits Management guidelines applicable to Plan programs are maintained by Carelon. 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. 9 Solutions: Musculoskeletal. 9 MR-guided Procedures 2021-01-01. Business hours: 8:00 am – 5:00 pm CST. We collect and analyze data from. Please consult the applicable health plan for more details. Offered through Carelon Medical Benefits Management (Formerly AIM Specialty Health) Provider portal. Status: Revised Effective Date: 04/14/2024. Obtaining prior authorization by phone can be a time-consuming process, from the arduous voice prompts to the length of time waiting to talk to an intake specialist, but there is a better way. 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. Pharmaceuticals,. The Guidelines do not address coverage, benefit or other plan specific issues. 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. AIM Specialty Health is now Carelon Medical Benefits Management. Participating in the Program is most easily managed using the Carelon ProviderPortal SM, available 24/7, or by calling Carelon directly. Program designs vary by health plan. Review Date. The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. 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'). Status: Created Effective Date: 12/30/2023. Precertification is performed by Carelon Medical Benefits Management, an independent company. Fax: 1-800-610-0050. Learn how the rehabilitation solution by Carelon Insights, formerly AIM rehab, helps accelerate better outcomes and costs of rehabilitation therapy. The guidelines do not address coverage, benefit or other plan specific issues. Carelon Contact Center Phone. Through impactful communication and education about the program, we are poised to engage you and your office support staff in the management of the complexities. Approval and implementation dates for specific health plans may vary. And that’s good news for. Carelon Medical Benefits Management* Our health plans may use guidelines developed by Carelon Medical Benefits Management, Inc.