SHBP Precertification Procedure Codes Sheet

Carelon Medical Benefits Management, Inc. – Carelon Medical Benefits Management is a nationally recognized leader in specialty benefits management. To submit your request for any of the services below, contact Carelon Medical Benefits Management online via ProviderPortal at providerportal.com. From the drop down menu, select Anthem- SHBP UM. You may also call Carelon Medical Benefits Management toll-free at 866-714-1103, Monday to Friday, 8 a.m. to 6 p.m. ET. Diagnostic Imaging Management – Diagnostic imaging management services are provided by Carelon Medical Benefits Management, a separate company, for certain health plan members. Diagnostic imaging services may be reviewed against Carelon Medical Benefits Management's Diagnostic Imaging Utilization Management Clinical Guidelines . Carelon Medical Benefits Management's Clinical Guidelines are available at https://guidelines.carelonmedicalbenefitsmanagement.com. If you have any questions about which guidelines are applicable, please call the customer service number on the back of the member’s ID card. Musculoskeletal (MSK) Program (including spine and joint surgeries, interventional pain management, level of care/setting reviews, pre-op days/expected inpatient length of stay).

Learn more: Anthem- SHBP UM Medical Policies Clinical Guidelines precertification code list (PDF)