Portal updates

When should I fax or upload documents to Carelon?

Did you know that when submitting a case, the Carelon Medical Benefits Management provider portal will let you know when you need to upload additional documents? Following the guidance throughout the provider portal and answering the clinical questions accurately and completely is the most efficient method of getting your case reviewed as quickly as possible. Carelon has designed the clinical questions in a very deliberate manner, intended to gather only relevant information that will allow us to adjudicate the request appropriately. Limiting clinical document uploads to only those situations where they are needed helps to ensure that only the minimum amount of information necessary to perform a service is requested.

If your case does not get approved right on the provider portal, there is an option to type in relevant clinical information in the Additional Information textbox when the case is submitted. The character limit on this textbox has been expanded for most of our programs (most recently for Radiology).

When additional clinical documents are requested, you will have an option to upload your documents at case submission. It is best practice to identify the pertinent information in the patient’s chart for the requested service, and only upload those specific pages on the portal. When Carelon requests documents, it is always better to upload than to fax. When documents are faxed, there can be delays in the documentation getting attached to the case. We know documentation needs can be confusing, so let the provider portal be your guide.

What’s new in Portal?

In becoming Carelon Medical Benefits Management, we have recently applied some updates to our provider portal.

• Carelon branding and name changes have been applied throughout the portal, though our direct link has not changed: providerportal.com.
• You can still conveniently access our clinical appropriateness guidelines and cancer treatment pathways page, Provider Connections blog page, and provide microsites while signed in to the portal. Only the links to these sites have been updated and the former site links have been redirected to the new URLs.
• We have added a new footer, which provides easy access to our privacy, terms of use, and Provider Connections blog pages.
• Each of the provider portal pages has also been updated with the new footer.

For more information

If you need technical support with the Carelon provider portal or new users at your office require registration assistance, please contact 1-800-252-2021, option 2, weekdays 8 AM – 7 PM EDT. Please feel free to provide feedback ongoing to us via WebCustomerService@carelon.com

External submission scenarios:
If you currently use a dedicated health plan/payer portal to submit prior authorization requests, please continue to use that portal to submit requests to Carelon Medical Benefits Management. Note: Some provider portal information included in our blog may not pertain to your user experience.