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.

Carelon provider portal

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

Learn More

Expanded Surgical Site of Care reviews became effective December 1, 2020 in most Anthem markets.

Surgical Site of Care reviews for Empire members became effective January 1, 2021.

See Resources tab for details

* As a reminder, the last 2 digits of the member’s ID number can be omitted.

Provider Webinar

The Surgical Site of Care provider portal experience

Learn the upcoming feature of the Carelon Surgical Procedures Program.

Get the details and register here