Support documentation for Carelon Medical Benefits Management, Inc. prior authorization requests

As part of our ongoing quality improvement efforts, we want you to know that some review requests may require documentation to substantiate the attestations that support the clinical appropriateness of the request. This documentation can be uploaded during the intake process.

When requested, providers must submit such documentation from the patient’s medical record. If medical necessity is not supported through documents submitted, the request may be denied as not medically necessary. Such documentation is limited to what has been asserted via the prior authorization (PA) review attestations. 

If the request would be denied as not medically necessary, providers can participate in a PA discussion with an Carelon Medical Benefits Management physician reviewer.