Healthcare partners

Carelon Medical Benefits Management (MBM), is a utilization review accreditation commission (URAC) certified, innovative, technology-driven care management company focused on serving and keeping clients in their home through intelligent, connected care. Carelon provides delegated benefit management services for post-acute care, including utilization management (UM) and claims payment services.

Carelon has dedicated staff and resources to support your participation in our network by providing:

• Technology-driven care management services for members to keep them healthy and independent in their home
• Administrative and benefit management services delivering quality outcomes for services traditionally provided in the home
• The appropriate care to members at the right time
• Lower costs to the health care delivery system by preventing unnecessary readmissions

Carelon is excited to partner across the healthcare ecosystem, from trade associations to technology, from care delivery to care coordination, from suppliers to systems, in order to bring communities of caring together to better serve people. We focus on the delivery of cost effective services that reduce risks, promote independence, and improve quality of life for members and families.

Privacy reminder:

Help us protect patient PHI: When submitting a case on the provider portal, be sure to select and verify the correct office demographic information for the ordering provider (office address & fax number) and servicing provider (office address) as letters with patient PHI are sent.

Program resources

• Contracting: Please find the Carelon post-acute care contracting information form here.

• Portal Support: Please find the Carelon post-acute provider portal FAQ here.

Carelon Medical Benefits Management
103 Powell Court | Suite 425 | Brentwood, TN 37027
Provider call center phone: 844-411-9622

Contact us | Privacy policy | Terms of use

An individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 USC § 2000d et seq. – PDF (race, color, national origin, sex, age, sexual orientation, gender identity, and disability), Title IX of the Education Amendments of 1972, 20 USC § 1681 et seq. – PDF (sex), the Age Discrimination Act of 1975, 42 USC § 6101 et seq. (age), or Section 504 of the Rehabilitation Act of 1973, 29 USC § 794 – PDF (disability), under any health program or activity, any part of which is receiving Federal financial assistance, or under any program or activity that is administered by an Executive Agency or any entity established under Title I of the Affordable Care Act or its amendments. OCR has enforcement authority with respect to health programs and activities that receive Federal financial assistance from the Department of Health and Human Services (HHS) or are administered by HHS or any entity established under Title I of the Affordable Care Act or its amendments. Carelon Medical Benefits Management employs industry standard information security systems including, but not limited to: Unified Threat Management (UTM), Vulnerability Threat Management (VTM), Data Loss Prevention (DLP), and Security Information and Event Management (SIEM), Email Encryption, and Secure Sockets Layer (SSL) certificates. Inquiries regarding Carelon’ information security and privacy policies, procedures or activities may be directed to the Privacy Team through email.