Carelon Medical Benefits Management Tipsheet Form

Carelon Medical Benefits Management’s (formerly Carelon Specialty Health) prior authorization services improve provider efficiency for
pre-service and post-service reviews. Applies to some Blue Cross and Blue Shield of Oklahoma (BCBSOK) commercial members. The Carelon ProviderPortal® will simplify pre- and post-service reviews. • Use the Carelon ProviderPortal to request prior authorization (pre-service) • Post-service review requests should also be submitted directly to Carelon via the ProviderPortal • Do not submit medical records to BCBSOK for care categories managed by Carelon • If medical records are needed, Carelon will request them via the ProviderPortal Care categories that require prior authorization through Carelon effective Jan. 1, 2021. • Advanced imaging and cardiology
• Joint and spine surgery, pain management • Genetic testing
• Radiation therapy
Benefits will vary based on the service being rendered and individual and group policy elections. Always check eligibility and benefits first, through Availity® or your preferred web vendor. This step will confirm coverage and other important details, such as prior authorization requirements and vendors. Blue Cross and Blue Shield of Oklahoma, a Division of Health Care Service Corporation,
a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association. 611440.0423 Tips for Using Carelon Medical Benefits Management

Carelon’s Portal Offers End-to-End Efficiencies for pre- and post-service reviews. • Self service available 24/7
• Smart clinical algorithms mean real-time eterminations, in many cases • Transparent feedback before transferring to clinical review • Check order status and view order history • Increases payment certainty • Reference desk training and tutorials Provider resources: • You can access and register for the Carelon ProviderPortal here. • If you have questions or issues with the ProviderPortal call the Carelon support team at 800-252-2021. • Check out our Carelon provider microsite for training webinars, clinical guidelines and other resources. • Find code lists that require prior authorization in the Utilization Management section of the BCBSOK
provider website. Carelon Medical Benefits Management is an independent company that has contracted with Blue Cross and Blue Shield of Oklahoma to provide utilization management services for members with coverage through BCBSOK. Availity is a trademark of Availity, L.L.C., a separate company that operates a health information network to provide electronic information exchange services to medical professionals. Availity provides administrative services to BCBSOK. BCBSOK makes no endorsement, representations or warranties regarding third-party vendors and the products and services offered by them. Blue Cross®, Blue Shield® and the Cross and Shield Symbols are registered service marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans.