Provider Manual

E-commerce requirements

Effective January 1, 2015, providers in the Carelon network will be expected to electronically conduct all routine transactions, including:

• Submission of claims
• Submission of authorization requests
• Verification of eligibility inquiries
• Submission of re-credentialing applications
• Submission of POMS
• Electronic fund transfer
• Provider claims and authorization status checks

New providers with a contract date of July 1, 2014 or later will be expected to comply immediately with this requirement upon joining Carelon.

To conduct these transactions referenced above, Carelon requires providers to utilize the resources detailed in the Electronic Resources section of Carelon’s website.  Additional information on E-support Services/ProviderConnect and Electronic Claims can be found here: https://www.carelonbehavioralhealth.com/providers/resources/provider-portals

If a participating provider does not submit claims electronically, claims may be delayed. 

For questions or further assistance regarding this requirement, please contact your Provider Field Coordinator or call the Carelon Provider Service Line at (800) 397-1630 Monday through Friday, 8 a.m. to 8 p.m. EST.