Portal updates

Carelon MBM peer-to-peer (P2P) scheduling modernization:
Genetic Testing and Surgical Procedures Solutions update

Moving from a phone-based, manually coordinated peer-to-peer (P2P) scheduling process to a digital model will greatly improve the experience for both external providers and our internal Carelon teams.

Effective this June, we’re expanding the rollout of our self-service peer-to-peer (P2P) scheduling feature in the Carelon MBM provider portal. With automated scheduling, improved tracking, and greater visibility, external physicians will be able to secure P2P appointments more quickly and easily. This modernized approach is designed to boost efficiency, reduce administrative burden, and help ensure faster access to clinically appropriate decisions.

Scheduling note: If there are no peer‑to‑peer time slots available within the next 10 business days, a message will appear prompting user to call Carelon to schedule a P2P:
Currently we are unable to process your request. Please contact Carelon Medical Benefits Management for further assistance.

To support a smooth transition, the automated P2P capability will roll out in phases. Phase one launched April 20, 2026, for Musculoskeletal (MSK) clients and providers across all lines of business, for Anthem plans only. Phase two launched June 8, 2026, for all Medical Oncology clients and providers, and external MSK clients and providers.

We’re excited to share that this capability will now go live for all Genetic Testing (GT) clients* and providers on Monday, June 15, 2026, and for all Surgical Procedures clients and providers on Monday, June 22^, 2026.

For our other Carelon solutions that are out of scope at this time, providers can continue to call in to request peer-to-peer appointments. Continued rollout updates will be included in upcoming editions of Provider Connections and on our blog site.

Please refer to our peer-to-peer self-service scheduling presentation for a preview of the new process.

*Not applicable for Anthem Blue Cross and Blue Shield of Georgia Commercial and Blue Cross and Blue Shield of Illinois Medicaid business

Provider portal release update: Carelon Provider Portal Message Center enhancements go live for our Radiology and Cardiovascular Solutions effective May 18, 2026

For Radiology and Cardiovascular Program providers / provider portal users

Carelon recognizes the essential role medical practices play in delivering patient care. As a leader in clinical appropriateness review, we continue to enhance the Carelon provider portal to make the clinical review process more efficient.

For those who submit Radiology and Cardiovascular requests through the Carelon provider portal, we will be enhancing the provider portal Message Center to help save you time and improve your experience.

What’s changing?

Effective May 18, 2026, the Secure Message Center module which is accessible from the header on the provider portal dashboard, will include an enhanced secure messaging module. This module will serve as a central location to view messages from Carelon and respond when needed.

What does this mean to you?

When you log in to the provider portal on or after May 18, 2026, you will be able to:

• Easily find Carelon communications related to your requests
• Receive portal notifications relevant to your activity and experience

How does it work?

• This new feature lets you submit additional information or clarify clinical details online to help expedite Radiology and Cardiovascular Medicare request reviews—without needing to call Carelon.
• Carelon clinical reviewers can also use the feature to notify you when information is missing from a case, supporting timely and appropriate clinical decisions.

Example of the Secure Message Center module:

Learning opportunities

Demonstrations and Q&A will be included in our upcoming provider webinars. Visit the Training page of our Provider Connections website for more information. Scroll down to the Training section to see upcoming training dates.

You can access a preview of the updates here.

For more information

If you need technical support with provider portal, please contact 1-800-252-2021, option 2, week days 8 am – 7 pm EDT.

Introducing a new look and feel to our provider portal

The Carelon MBM provider portal is getting a new look! We’re starting to roll out the Carelon color palette, beginning with Registration, Provider Management, and Reset Password sections of the portal

More updates will come over time. Portal functionality is not impacted by the design changes.

Example – New look of the Password reset page:

Carelon MBM uses multi-factor authentication (MFA) for secure access to its specialty benefits and post-acute provider portals

What is multi-factor authentication (MFA)?

Multi-factor authentication (MFA) is a multi-step login process that requires system users to enter their username and password followed by additional information such as a code sent to their email or phone. In some cases, the additional authentication step may involve answering a secret question that’s been set up ahead of logging in.  Another name that is commonly used for this type of authentication is two factor authentication or 2FA.

Why is MFA important?

Companies commonly use MFA authentication today to protect their own systems, but also to protect those using their systems. Requiring MFA helps protect all against security issues such as compromised login information and phishing attempts. A phishing attempt is an email that tries to obtain confidential information like credit card numbers, user names or passwords.

Carelon MBM provider portal users are automatically logged out after a period of inactivity. This measure protects your account and safeguards members’ PHI.

Need assistance with MBM specialty provider portal? 

For assistance using the MBM specialty provider portal, contact us by email or at 800-252-2021.

To access step by step instructions for the Carelon provider portal MFA process, click here.

Additional information for post-acute NexLync portal users

Effective September 20th, all post-acute NexLync portal users will begin using our multi-factor authentication. This will be a one time roll out and will be applicable for both existing users and new users.

You will be automatically enrolled with the email that you used to register your portal account. Upon each sign in, users will be given the option to receive a one-time code either via their registered email or the authenticator app.

Please note: So that you can watch for it and avoid any company spam/security blocking, the authentication code will be sent to you from the following Carelon email address: noreply@okta.com.

Once you enter the verification code from your desired method, you should be able to access your portal account as you do today.

Carelon MBM has decided to implement this process in efforts to protect member information, our own systems and those utilizing our systems.

Please see Multi-factor authentication FAQ’s and Instructions below.
Multi-factor authentication FAQ: click here for FAQ
Multi-factor authentication instructions: click here for MFA Instructions

If you experience any issues with our MFA or need any further assistance, please reach out to the Portal Support team by completing this form here.

Provider Portal: As a reminder, our provider portal is the quickest and most efficient way to request authorization. If you have not already done so, we encourage you to sign up for the Carelon Provider Portal by clicking here.

Thank you for your continued partnership.

Reminder: Use the Carelon provider portal for Home Health, DMEPOS, PAC-IM, SDoH and Wound Care providers to submit prior authorization requests*

Our Carelon provider portal is the quickest and most efficient way to request authorization, provides real-time processing and updates, plus access to archive authorizations should you need to reference them.

Not yet registered? Follow our easy to reference Getting started guide available here or below.

Before you begin the registration process, be aware of the items below:

• Each person in your office who will be using the portal should register their own account. Users should not share portal accounts.
• For providers, you will need to enter the 10-digit NPI.
• For providers only, you will also need to enter your Tax ID.
• You will need to provide your preferred business email address. (No duplicates allowed)
• You will need to provide your preferred business phone number and fax number.

To register

• ‘Accept’ Agree to Terms.
• Click ‘Begin’ to start.
• Click the “Provider Type” dropdown and select your provider type.
• For Providers – Enter your organization’s 10-digit NPI in the “Provider NPI” field. The portal displays providers that match your entry.
• If you cannot find your organization, you will need to call Carelon @ 1-844-411-9622 option 4 for assistance.
• Select your organization.
• Complete the other fields on the page then click Continue and Submit button.

Additional information on our registration process can be found here.

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.