Carelon Medical Benefits Management recognizes the key role that you and other providers play in the delivery of care for patients. Developed in collaboration with your patients’ health plans, our Additional Outpatient Utilization Management (UM) Solution helps support quality care that is consistent with established best practices. And that’s good news for your practice and the patients you serve.

Our process

Based on the clinical information you submit, we conduct clinical appropriateness review of your requests against clinical guidelines and health plan medical policies, providing you with a central location to obtain authorizations required by your patients’ health plans.

Our program reviews services including, but not limited to:

• Additional Outpatient – Miscellaneous outpatient services, i.e., nutrition, hematology, neuromuscular, special dermatological procedures
• Transportation – Transport by ground, air, or water for emergent and non-emergent medical reasons

Note: Review requirements and modalities may vary by health plan. Please verify or check with the patient’s health plan if you have any questions.