Prior Authorization Requests

Carelon Behavioral Health embraces opportunities to foster collaboration efforts with providers to help ensure our members are receiving quality and appropriate care. To this end, we regularly review our policies and procedures to ensure our prior authorization reviews are appropriately addressing members' level of need based on medical necessity criteria.

This communication is to clarify that each prior authorization request will be reviewed based on the member’s medical necessity for the respective level of care being requested and not solely on the number of days requested by the providers.

If the specific number of days requested is not completely authorized with the initial request, we encourage providers to submit additional clinical information that supports continued care at the next review date. This will help minimize unnecessary telephonic contact and, as a result, will decrease the number of partial denials that are received.

We are grateful for your care of our members and look forward to continued collaboration.