Carelon Post Acute Solutions | DMEPOS Program
Carelon Post Acute Solutions 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.
July 1, 2023 | Delegation information
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.
Notice: The delegation notice and orientation letter mailed to providers is available below by market:
CO, CT, GA, IN, KY, MO, NV, NH, OH, VA, WI
NM, TX, WA, TN, NJ
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 plan list: The list of in-scope plans
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.
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:
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