Health plans will be utilizing medical policy and/or Carelon clinical guidelines to review for medical necessity.Improving the clinical appropriateness of imaging services through the application of evidence-based guidelines in an efficient and effective review process.Your practice can benefit from participation in several ways, including:.How does the program benefit my practice and patients? Claims submitted for radiology services performed on or after the effective date will not be paid if prior authorization has not been obtained through the Radiology Program. Your participation is required when requesting diagnostic imaging services for health plan members. The requests are evaluated against evidence-based, Carelon Clinical Guidelines. The Advanced Imaging Program is a utilization management program that requires providers to request prior authorization for advanced imaging services. What is the Radiology/Advanced Imaging Program? This program will be administered by Carelon. We promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. ![]() Our mission is to help ensure health care services are more clinically appropriate, safer, and more affordable. Who is Carelon Medical Benefits Management? How will the program be administered?Ĭarelon is a leading specialty benefits management company with more than 25 years of experience and a growing presence in the management of radiology, cardiology, genetic testing, oncology, musculoskeletal, sleep management, surgical, and rehabilitation.
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