Carelon resources for providersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. This is a courtesy reminder that diagnostic imaging services requested on or after November 1, 2021, Anthem Blue Cross and Blue Shield’s Federal Employee Program (FEP) transitioned to AIM Specialty Health ® (AIM). If you have questions, call Carelon at 86. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. Prior authorization isn't required for the following: drug that require prior authorization by calling the phone number on the back of your identification card or check our website at The list. To determine if the AIM Musculoskeletal Program applies to an Anthem member on or after November 1, 2021, providers can contact the Provider Services phone number on the back of the. To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. A complete list of CPT codes requiring prior authorization for the AIM Musculoskeletal site of care program is available on the AIM Musculoskeletal microsite. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines. ![]() The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Prior authorization is based on member benefits and eligibility at the time of service. Providers must make prior authorization requests through Carelon for members on plans that require it. ![]() Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. Prior Authorization Lookup Tool (PLUTO) located on the. ![]() Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross. Beginning March 18, 2019, providers will be able to contact AIM for prior authorization for services to. Learn more about the provider resources available to help your healthcare organization manage care and cost and improve patient outcomes. AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023. For questions about the provider network: Call 1-83 or email our network team.
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