Cambia

Carelon Post-Acute Care | PAC-IM

Carelon Medical Benefits Management is excited to announce the partnership with Cambia Health Solutions, LLC for management of in-patient post-acute care services for Medicare Advantage members in the states of Idaho, Oregon, Utah, and Washington effective February 1st, 2024.

Please find important announcements, documents, and forms listed below for each of these delegations:

Current announcements

February 1, 2024 | Delegation information

Delegation:
Effective February 1, 2024, Carelon will begin managing in-patient post-acute care services for most members in the states of Idaho, Oregon, Utah, and Washington. Delegated services include Utilization Management.

Training sessions:
Registration for provider training sessions can be found online here.

Contact:
Email us with questions related to this delegation.

Provider information form

PAC-IM Facilities (SNF, IRF, LTACH only): Please ensure you are registering for the portal under the “Post-Acute Facility” option. If your facility information is not available in the Carelon portal, please complete the “Provider information form” found online here.

Authorization program materials

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

In-Scope plans:
In-Scope Plan List: The list of in-scope Cambia plans for the Carelon delegation

Fax request forms

Initial and continued stay request fax forms can be found below by setting type:

Fax forms for Skilled Nursing Facilities (SNF):
SNF initial request fax form
SNF continued stay request form

Fax forms for inpatient rehabilitation facilities (IRF):
IRF initial request fax form
IRF continued stay request form

Fax forms for Long-Term Acute Care Hospitals (LTACH):
LTACH initial request fax form
LTACH continued stay request form