Welcome

Carelon Medical Benefits Management recognizes the key role that you and other medical practices play in the delivery of care for patients. Developed in collaboration with your patients’ health plans, our Surgical Procedures reviews help support quality care that is consistent with evidence-based medicine. And that’s good news for your practice and the patients you serve.

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 clinical guidelines and health plan specific medical policies to ensure alignment with current best practices. Providers benefit by having a central location to obtain authorizations required by your patients’ health plans.

Our program reviews outpatient, non-emergency Surgical and Endoscopic procedures

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.

Procedures within the scope of this program include but are not limited to:

• Upper GI Endoscopy (EGD)
• Colonoscopy
• Monitored Anesthesia Care for Upper and Lower GI Procedures
• Procedures of Colon and Rectum
• Procedures of Esophagus
• Procedures of Intestines (except Rectum)
• Procedures of Accessory Sinuses
• Procedures related to Abdomen/Peritoneum & Omentum
• Procedures of Anterior Segment of Eye
• Procedures of Anus
• Procedures of Bladder
• Procedures of Cervix Uteri
• Procedures of Corpus Uteri
• Procedures of Conjunctiva
• Procedures of Ear/Auditory Canal
• Procedures of Extracranial Nerves, Peripheral Nerves, and Autonomic Nervous System
• Procedures of Integumentary system (General)
• Procedures of Kidney
• Procedures of Lacrimal system
• Procedures of Larynx
• Procedures of Lips
• Procedures of Liver
• Procedures of Male genital system
• Procedures of Mouth/Buccal cavity
• Procedures of Musculoskeletal system
• Procedures of Nasal Structures
• Procedures of Ocular Adnexa
• Procedures of Oviduct/Ovary
• Procedures of Pilonidal Cyst
• Procedures of Posterior Segment of Eye
• Procedures of Skin, Subcutaneous, and Accessory Structures
• Procedures of the Adenoids/Throat/Tonsils
• Procedures of the Palate and Uvula
• Procedures of the Salivary Ducts and Glands
• Procedures of the Teeth and Supporting Structures
• Procedures of Trachea and Bronchi
• Procedures of Ureter
• Procedures of Urethra
• Procedures of Vagina
• Procedures of Vulva, Perineum, and Introitus