– PDF (sex), the Age Discrimination Act of 1975, 42 USC § 6101 et seq. – PDF (race, color, national origin, sex, age, sexual orientation, gender identity, and disability), Title IX of the Education Amendments of 1972, 20 USC § 1681 et seq. Please contact the Carelon provider network team with any questions by email or:Īn individual shall not be excluded from participation in, be denied the benefits of, or be subjected to discrimination on the grounds prohibited under Title VI of the Civil Rights Act of 1964, 42 USC § 2000d et seq. A synopsis of the criteria is available to Providers and Members on request and free of charge by calling Carelon at 83 or by email. Contact usĬarelon utilizes CMS National and Local Coverage Determinations (NCD and LCDs) when applicable, or Aetna medical policies and clinical Utilization Management guidelines to facilitate the appropriate evaluation of medical necessity by including assessment of the member throughout the continuum of care. Provider change form: Online form providers use to update information. NPI, address, or phone), please submit the Provider change form found below. If you are an existing Carelon Participating Provider and need to update any of your Provider Information (i.e. Please contact the Carelon claims team for questions related to the claims process by calling 83. Payment dispute request form out-of-network providersĬlaims waiver of liability form for out of network providers Payment dispute request form in-network providers To enroll in the EFT program, please register for EFT payments by completing the online application form: Please find important forms related to the Carelon Claims Process listed below.Įlectronic funds transfer (EFT) enrollment:Ĭarelon offers EFT payment options for providers. The Carelon payer ID for the Aetna delegation is: 34010. If you are ever in doubt, please submit a request through the Provider Portal, and our reviewers will let you know. ![]() IV skilled nursing reviews are based on medical necessity, caregiver’s ability/willingness, and the member’s medical conditions. wound care, COPD care, diabetic management, etc.) then you would still submit an authorization request for those -SN services. If you are considered bundled, but the SN is performing other skilled services (i.e. An agency is considered bundled if IV SN visits are billed to the DME/Infusion company (supplying the member). An agency is considered unbundled per IV billing status when IV SN visits are billed to the member’s insurance for reimbursement. Carelon does manage infusion (IV) requests if the agency has an unbundled IV billing status. Re-authorization request form: Fax form to use for re-authorization requests if needed.įax confirmation form: Online form providers use to confirm their fax numbers for authorization requests. Initial authorization request form: Fax form to use for initial authorization requests if needed. ![]() The Provider portal can be found online here. Provider portal: Carelon encourages providers to utilize the online Provider portal to submit authorization requests. In-scope plan list: The list of in-scope Aetna plans for the Carelon delegation. Please complete the “Agency information form” to have your agency’s information added to the Carelon system. Notice: The delegation notices mailed to providers can be found by market below. Delegated services include Utilization Management, Network Management, and Claims Reimbursement. Current announcements CT and FL: Jdelegation informationĭelegation: Effective July 1st, 2023, Carelon will manage Aetna Medicare Advantage (MA) plans in the states of Connecticut and Florida. ![]() Please find important announcements, documents, and forms listed below. Follow the list and Avoid Tfl denial.Carelon Post Acute Solutions is proud to announce its partnership with Aetna to provide utilization management for home health services in Connecticut, Florida, Georgia, Kentucky, Missouri, Ohio, Oklahoma, Pennsylvania, Texas, Virginia, and West Virginia. One such important list is here, Below list is the common Tfl list updated 2022. There is a lot of insurance that follows different time frames for claim submission. One of the common and popular denials is passed the timely filing limit.
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