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.

Provider webinar

The Rehabilitation Carelon provider portal experience

Learn to enter your rehabilitation services order request online.

2023-2024 Webinar Training Calendar 

Information regarding COVID-19 and Telehealth

Certain CPT codes will be appropriate to be considered for Telehealth (audio and video) for physical, occupational, and speech therapies. See FAQs for more details. Also, please check your market website often for the latest Anthem COVID-19 information.

Processing requests for 

Blue Cross and Blue Shield New Mexico:

Effective 1/1/21 Blue Cross Centennial Community NM


Effective 5/1/23: Healthy Blue NC
Effective 1/1/21: Healthy Blue MO
Effective 4/1/19: IN, NY, WNY, and WI

Effective 11/1/19: CT, ME, NH, NY, GA, IN, KY, MO, OH, and WI
Effective 4/1/20: CO and NV
Effective 11/1/22: VA

Effective 4/1/20: CA, CO, CT, GA, IN, KY, ME, MO, NH, NM, NY, OH, TN, TX, VA, WA, and WI
Effective 6/1/20: TX MMP

Autism Spectrum Disorder:

Anthem and Carelon are working together to make improvements to the clinical review of PT/OT/ST Services when used to treat Autism Spectrum Disorder or Pervasive Developmental Disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.  See FAQs for more information.

Provider portal

The provider portal is your access point for submitting order requests online.

Learn more