We have updated our process for prompt payment of claims. Sunshine Health values our relationship with our provider partners and are pleased to announce updates for Screening, Brief Intervention and Referral to Treatment (SBIRT) for persons with substance use disorders. Screening, Brief Intervention and Referral to Treatment (SBIRT) To register for an upcoming Town Hall or watch recordings of previous Town Halls, visit our Training web page.
#PROVIDER PORTAL AIM SPECIALTY HEALTH SERIES#
Our Town Hall series is ongoing however, we modified our existing process to separate the sessions and make them more specific to specialty types. Please register in advance-space is limited. Provider Town Halls cover a variety of post-integration updates to better assist you in navigating our processes. The provider portal is your access point for submitting order requests online.Important Provider Updates Join a Provider Town Hall See FAQs for more information Provider portal
#PROVIDER PORTAL AIM SPECIALTY HEALTH MANUAL#
Processing requests for Blue Cross and Blue Shield New Mexico:Įffective : Blue Cross Centennial Community NM Anthem:Įffective : CT, ME, NH, NY, GA, IN, KY, MO, OH, and WIĮffective : CA, CO, CT, GA, IN, KY, ME, MO, NH, NM, NY, OH, TN, TX, VA, WA, and WIĮffective : TX MMP Autism Spectrum Disorder:Īnthem and Carelon are working together to make improvements to the clinical review of PT/OT/ST Services when used to treat Autism Spectrum Disorder or Pervasive Developmental Disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association.
See FAQs for more details, Also, please check your market website often for the latest Anthem COVID-19 information. Information regarding COVID-19 and TelehealthĬertain CPT codes will be appropriate to be considered for Telehealth (audio and video) for physical, occupational, and speech therapies. Learn to enter your rehabilitation services order request online. The Rehabilitation Carelon provider portal experience Please verify or check with the patient’s health plan if you have any questions. Note: Review requirements and modalities may vary by health plan. Our program reviews outpatient rehabilitative services including, but not limited to: This decision can be made immediately if all relevant clinical information is provided. Therapy providers and physicians benefit by having a central location to obtain authorizations required by your patients’ health plans. The clinical information you submit is reviewed against Carelon clinical guidelines and health plan specific guidelines to ensure alignment with current best practices. The program includes review of rehabilitative and habilitative outpatient physical, occupational and speech therapy services for medical necessity.Ĭarelon is here to assist in your efforts to deliver the best quality and affordable care for your patients. Carelon Medical Benefits Management recognizes the key role that you and other providers play in the delivery of care for patients needing rehabilitative services to improve, adapt or restore functions, which have been impaired or permanently lost.ĭeveloped in collaboration with your patients’ health plans, our Rehabilitation Program provides a clinical appropriateness review process that encompasses the appropriate duration of rehabilitation services.
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