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.
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.
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:
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.
Search by Member feature has been enhanced:
Search by Order ID feature has been enhanced:
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.
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.
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.