Carelon Medical Benefits Management recognizes the key role that you and other medical practices play in the delivery of care for patients with musculoskeletal conditions and chronic pain. Developed in collaboration with your patients’ health plans, our Musculoskeletal Program helps support quality care that is consistent with evidence-based medicine. And that’s good news for your practice and the patients you serve.

Our process
Carelon is here to assist in your efforts to deliver the best quality and affordable care for your patients. The clinical information you submit is reviewed against Carelon clinical guidelines and health plan specific medical policies to ensure alignment with current best practices. Providers benefit by having a central location to obtain authorizations required by your patients’ health plans.

Our program reviews inpatient and outpatient non-emergency treatment or procedures.

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.

Treatments and procedures within the scope of this program include but are not limited to:

Spine surgery – Cervical, thoracic, lumbar, sacral and sacroiliac joint fusion

• Bone grafts
• Bone growth stimulators
• Cervical/lumbar foraminotomies
• Cervical/lumbar spinal fusions
• Cervical/lumbar spinal laminectomy
• Cervical/lumbar spinal discectomy
• Cervical/lumbar spinal disc arthroplasty (replacement)
• Spinal deformity (scoliosis/kyphosis)
• Vertebroplasty/kyphoplasty

Joint surgery

• Hip arthroplasty
• Knee arthroplasty
• Shoulder arthroplasty
• Hip arthroscopy
• Knee arthroscopy
• Shoulder arthroscopy
• Treatment of osteochondral defects
• Meniscal allograft transplantation
• Small joint surgery
  • Total ankle replacement
  • Hammertoe correction
  • Bunionectomy
  • Hallus rigidus
  • 1st toe arthrodesis

Interventional pain management

• Epidural steroid injections
• Paravertebral facet joint injection/Nerve block/Neurolysis
• Sacroiliac steroid injections
• Spinal cord stimulators
• Regional sympathetic nerve block

Coming soon: Carelon’s Total Movement Care Program*

Effective this July, Anthem providers in 11 commercial markets states, will be introduced to Total Movement Care, which is our clinically guided program that connects commercial members experiencing muscle, joint, or back pain to the right care, at the right time – through one coordinated journey, at no additional cost to them.

Total Movement Care is our new member-facing musculoskeletal program comprised of four selected musculoskeletal care coordinators, each offering assistance in distinct markets.

With Total Movement Care, coordinators help guide members to:

• Access expert care faster: A virtual first discussion of care reduces delays, unnecessary referrals, and friction across the care journey.
• Get the right care from the start: Clinician‑led assessments identify root cause, discuss treatment pathways and direct members to the most appropriate provider.
• Develop personalized treatment plans: Care plans may include virtual physical therapy and guided home programs.
• Navigate coordinated, in‑network care: Seamless referrals to imaging, specialty consults, and in‑person care when it is needed.

One ecosystem. One coordinated journey.
Total Movement Care has engaged four musculoskeletal care coordinators —each assigned to a specific geography—to support coordinated, evidence‑based care.

The vendors include:

• HOPCo
  HOPCo serves as an early access entry point for non-urgent MSK conditions, delivering evidence-based care management, and coordinated transitions to in-person care when clinically appropriate. Markets: IN, KY, OH, VA; CO, MO (2027 deployment)
• RightMove
  RightMove provides a virtual clinical assessment to evaluate your patient’s MSK condition and coordinate next steps, whether that’s physical therapy, imaging, or specialist care. Markets: CT, ME
• TailorCare
  TailorCare serves as a comprehensive destination for all patient MSK care navigation and scheduling. Licensed doctors of physical therapy (DPTs) help arrange appropriate care and patient-centered support using evidence-based guidelines and shared decision-making throughout their care journey. Markets: GA
• Vori Health
  The Total Movement Care program by Vori Health is a comprehensive MSK solution and multidisciplinary telehealth care model that combinines physician, PT, nutrition, and behavioral support. Proven digital engagement performance across employer and payer programs. Markets: WI, NH

Built to complement existing relationships
Total Movement Care is designed to work alongside existing primary care physician (PCP) relationships – guiding, not diverting, patients toward the most appropriate care. Providers remain the central point of care, with our program supporting your clinical management.

*Total Movement Care will be available to additional markets and clients at a future date. Watch for updates on our Provider Connections blog site and newsletter.