Bookmark the new Broker Launchpad – guiding you to the right tool at the right time. View launchpad.

Close

Carelon, our medical benefits manager, begins conducting medical necessity reviews

Large Group, Small Group, Individual, National | CO, CT, IN, KY, ME, MO, NH, NV, OH, VA, WI, CA, GA, NY-DOWNSTATE, NY-UPSTATE

Effective August 1, 2023, Carelon Medical Benefits Management, our medical benefits manager, began performing medical necessity reviews of procedures we previously conducted. This change applies to all fully insured, local ASO, and National groups with Wellbeing Solutions programs. It will improve the member and provider experiences by simplifying prior authorization processes. Additional codes may be added to the review process during this transition.

We’ve let our groups know about this transition, but the change is seamless to them and their employees. There’s no action you or your clients need to take, but we wanted you to be aware.