Carelon Medical Benefits Management partners with health plans to help ensure quality care while reducing costs associated with care that’s not evidence-based. In collaboration with you and your patient’s health plan, our medical oncology program helps ensure care that’s appropriate.
Program offerings vary by insurer. We encourage you to review the custom program details for each insurer.
Carelon Cancer Treatment Pathways are cancer treatment regimens intended to support quality cancer care and reduce unneeded variation in care and cost. They are developed through a rigorous process of integrating evidence-based literature with physician practice guidelines.
The Pathways worksheets are intended as reference guides. You will not be asked to submit them.
All pathways are reviewed annually, with the reviews divided among quarterly meetings. The last reviewed dates on the Carelon Medical Benefits Management worksheets coincide with their last review, which varies among worksheets. Effective dates are only updated when there is a change to the pathways. For detailed descriptions of updates to the Carelon Oncology Pathways, please see the review and updates summary on page 2 of the Cancer Treatment Pathways and Guidelines document.
Carelon has a designated email address for provider questions about the Medical Oncology program and case entry process. All member eligibility or claims questions should be directed to your health plan network representative.
Having issues with the Provider Portal? Contact our Carelon provider portal support team: (800) 252-2021.