Carelon Medical Benefits Management recognizes the key role that medical practices play in the delivery of care for patients with cardiovascular disease. Developed in collaboration with your patients’ health plans, our Cardiovascular Program 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 review process encompasses certain outpatient invasive and noninvasive diagnostic and interventional procedures including, but not limited to*:

Diagnostic services:

• Coronary angiography
• Arterial ultrasound
• Stress echocardiography (SE)
• Resting transthoracic echocardiography (TTE)
• Transesophageal echocardiography (TEE)

Interventional services:

• Percutaneous coronary interventions (PCIs) such as coronary stents, balloon angioplasty and atherectomy
• Peripheral Revascularization

Implantable cardiac devices:

• Pacemakers
• Implantable cardioverter defibrillators
• Cardiac resynchronization therapy

*Note: procedures reviewed may vary by health plan

Everyone I know that uses the online portal thinks it is the easiest one in the industry to use. And your clinical reviewers are always kind and make our jobs easy.

- Provider practice feedback