Carelon Medical Benefits Management recognizes the key role that you and other providers play in the delivery of care for patients needing rehabilitative services to improve, adapt or restore functions, which have been impaired or permanently lost.

Developed in collaboration with your patients’ health plans, our Rehabilitation Program provides a clinical appropriateness review process that encompasses the appropriate duration of rehabilitation services. The program includes review of rehabilitative and habilitative outpatient physical, occupational and speech therapy services for medical necessity.

Our process

Carelon is here to assist in your efforts to deliver the best quality and affordable care for your patients. The clinical information you submit is reviewed against Carelon clinical guidelines and health plan specific guidelines to ensure alignment with current best practices. Therapy providers and physicians benefit by having a central location to obtain authorizations required by your patients’ health plans. This decision can be made immediately if all relevant clinical information is provided.

Our program reviews outpatient rehabilitative services including, but not limited to:

• Physical therapy
• Occupational therapy
• Speech therapy

Note: Review requirements and modalities may vary by health plan. Please verify or check with the patient’s health plan if you have any questions.