Portal updates

Learn all about recent Carelon Medical Benefits Management provider portal updates

To provide the best user experience possible, Carelon implements enhancements to our Medical Benefits Management provider portal ongoing. Visit this section to learn about the latest new and improved provider capabilities implemented.

Carelon MBM provider portal ‘check order status’ enhancement implemented

In our recent Carelon Medical Benefits Management (MBM) provider portal release, we implemented an enhancement to our ‘check order status’ functionality that will benefit all portal users and save them time.

Prior to the release, the provider portal “check order status” module required a user to select a health plan and Carelon solution prior to searching for a member’s order ID. The portal then displayed the member’s requests for just the selected solution.

The enhancement implemented removed the requirement to select the health plan or solutions prior to pulling up the member’s cases across all solutions.

What’s new in Portal?

Enhancements and required system updates are applied to our Carelon Medical Benefits Management (MBM) provider portal on a regular basis. We’re pleased to share a summary of our latest enhancements implemented.

Medicare Appropriate Use Criteria (AUC) Clinical Decision Support (CDS) has been decommissioned as of 9/9/23. In the month prior, users were alerted to this change via informational messaging (see screen shot below) and directed to the government Medicare AUC website with the link labeled “View other qualified CDS Mechanisms”: https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/appropriate-use-criteria-program/cdsm.

Summary of updates applied:

  • The Medicare AUC/CDS tile (as shown in screen shot below) is no longer displayed.
  • The link to Medicare AUC/CDS in the title bar on the home page is no longer displayed.
  • Medicare AUC/CDS items in Help Center are no longer displayed.
  • Access to the Medicare AUC/CDS application is no longer an option during portal registration.
  • Users no longer have the option to enable/disable the Medicare AUC/CDS application from the User Role tab in Manage My Profile.
  • Admins no longer have the option to enable/disable the Medicare AUC/CDS application from the User Role tab in User Administration.
  • All users with access limited to the Medicare AUC/CDS application have had their portal accounts disabled.
  • Clients are no longer able to upload Medicare AUC/CDS cases via EMR.

A new Order Search module has been implemented. This eliminates the need to select a health plan and solution before searching as required by the current Check Order Status module.

  • The user will choose to search by Member or Order ID. When doing a search by Member, all orders for that member will be now be displayed instead of just the orders for the selected solution.
  • The existing Check Order Status module will still be available, for the time being, but will eventually be retired.

Search by Member feature has been enhanced:

  • When the user chooses to search by Member, the Member ID, Date of Birth, First Name and Last Name are required.
  • The search will display all orders found for that member regardless of solution.

  • The user can use additional filters such as Status, Ordering Provider, Service Date and Program to refine the list of orders if more than one is returned in the search results.

  • The user can also see a high-level description of the services in each order by clicking on Show Details.

Search by Order ID feature has been enhanced:

  • When the user chooses to search by Order ID, only the Member ID and Order ID are required.
  • There is no option to filter since the results will only return the one order associated to the Order ID entered.
  • The user can also see a high-level description of the services in the order by clicking on Show Details.

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.

Why can’t I enter cases online, but the call center can?

Results returned from our annual provider satisfaction survey for 2022 found that some respondents were unable to enter their patients’ cases online, but could get a case entered when contacting the Carelon Medical Benefits Management call center.

Carelon has a mechanism for adding health plans to your personal profile, which often is the solution for locating a member that is part of that health plan. If you are unfamiliar with how to do this, we have a helpful tutorial available in the Carelon MBM provider portal, located in our tutorial section under Provider Management.

You can also access the tutorial here: How_To_Update_Providers_Associated_With_My_Account.mp4

This tutorial is 1 minute, 15 seconds in length. It may also help solve why your providers had not been searchable when trying to enter cases for a health plan that had not been previously listed under your profile.

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.