The UniCare State Indemnity Plan partners with Carelon Medical Benefits Management (Carelon) to support the review process for certain services and procedures that require preapproval.
Our Provider Reference Sheet identifies which services are reviewed by UniCare, which are reviewed by Carelon, and how much notice is required.
Put the Carelon Medical Benefits Management provider portal to Work for You
Obtaining prior authorization by phone can be a time-consuming process, from the arduous voice prompts to the length of time waiting to talk to an intake specialist, but there is a better way. The best way to submit a review request is to use the Carelon Medical Benefits Management provider portal. It is:
• Self-service
• Available 24/7
• Customizable with physician information
• Easy to use and allows real-time determinations
Register your practice on the portal here.
Post Claim Clinical Appropriate (PCCA) Reviews
Carelon handles the Post Claim Clinical Appropriate (PCCA) Reviews for CPT codes in our Radiology, Sleep, Genetic Testing and Radiation Oncology solutions.
A PCCA review is for cases that are greater than 2 business days old, but not more than 2 years (730 days) old. To initiate a case, you need the following information:
- Member information
- Name
- DOB
- Patient HCID#
-
Claim #
-
Date of Service
-
CPT Codes
-
Diagnosis Codes
-
Medical Records
You can use the Carelon Medical Benefits Management provider portal or you can call 1-866-766-0247 to initiate the case.
Preapproval Resources
Carelon Medical Benefits Management Clinical Information Worksheets and Clinical Guidelines:
- Carelon Medical Benefits Management Clinical Guidelines: Advanced Imaging
- Carelon Medical Benefits Management Clinical Guidelines: Radiation Oncology
- Cardiac Imaging Preapproval Worksheet
- CT/CTA/MRI/MRA Preapproval Worksheet
- Myocardial Perfusion Imaging (MPI) or Stress Echocardiography (SE) Preapproval Worksheet
- PET-PET CT Preapproval Worksheet
- Carelon Medical Benefits Management Clinical Guidelines
