Anthem

Carelon Post-Acute Care | DMEPOS Program

Carelon Medical Benefits Management is excited to announce the partnership with Elevance Health Medicare Advantage for management of Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) services effective July 1, 2023. Please find important announcements, documents, and forms listed below.

Current announcements

July 1, 2023 | Delegation information

Delegation:
For services beginning on or after July 1, 2023, prior authorization requests for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) services will be reviewed by Carelon for place of service 12 (home), 13 (assisted living facility), and 14 (group home).

Delegated services include prior authorization requests for Medicare Advantage individual and group retiree members in the states of California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Tennessee, Texas, Virginia, Washington, and Wisconsin.

Contact:
Email us with questions related to this delegation.

Provider information form

DMEPOS providers: Please ensure you are registering for the portal under the “DMEPOS Provider” option. If your facility information is not available in the Carelon portal, please complete the “Provider information form” found online here.

Authorization program materials

In-scope plans:
In-scope plan list: The list of in-scope plans

Authorization requests:
Carelon provider portal: Carelon encourages providers to utilize the online provider portal to submit authorization requests. The provider portal can be found online here.

Authorization request form: Fax form to use for authorization requests if needed.

Fax confirmation form: Online form providers use to confirm their fax numbers for authorization requests.

Contact us

Carelon utilizes CMS National and Local Coverage Determinations (NCD and LCD’s) when applicable, or Anthem medical policies and clinical Utilization Management guidelines to facilitate the appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling Carelon at 844-411-9622 or by email.

Please contact the Carelon provider network team with any questions by email or:

Phone: 844-411-9622
Fax: 833-678-0223

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 Post Acute Solutions 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.