Wellpoint

For Commercial:

Carelon Post-Acute Care | PAC-IM Program

Carelon Medical Benefits Management is excited to announce the partnership with Wellpoint for management of in-patient post-acute care services for Commercial members in the states of Florida, Maryland & Texas effective January 1st, 2025.

Please find important current announcements, documents and forms listed below:

Current announcements

FL, MD & TX  | Commercial delegation information – 1/1/25

Carelon will begin managing in-patient post-acute care services for most commercial members in the states of FL, MD & TX effective 1/1/25. Delegated services will include utilization management.

A copy of the Florida provider notice can be found here.

A copy of the Maryland provider notice can be found here.

A copy of the Texas provider notice can be found here.

For access to the provider orientation, click here.

If you do not have the access code for the PAC-IM Provider Orientation, please contact Carelon MBM Provider Relations here.

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.

Carelon provider portal: Carelon encourages providers to utilize the online provider portal to submit authorization requests.

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

Access to clinical guidelines:
Please visit our MBM clinical appropriateness guidelines and pathways page to access our current post-acute guidelines for the PAC-IM Commercial delegation, which are listed by facility type:|

Inpatient Rehabilitation Facility (IRF)
Long Term Acute Care Hospital (LTACH)
Skilled Nursing Facility (SNF)

Email us with questions related to this delegation.

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 the numbers below or by email.

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

Phone #’s:
– Wellpoint FL: 833-529-8775
– Wellpoint MD: 833-529-8820
– Wellpoint TX: 833-529-8773

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.