Authorizations for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services for consumers with individual, group retiree solutions (GRS), and dual-eligible plans from Medicare Advantage

For services beginning July 1, 2023, prior authorization requests for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) services will be reviewed by Carelon Post-Acute Solutions, LLC.* The goal of this program is to ensure members receive the right product for the right duration of time in the home. This change will be applicable to the following markets: California, Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri, New Hampshire, New Jersey, New Mexico, Nevada, New York, Ohio, Tennessee, Texas, Virginia, Washington, and Wisconsin.

 

How to submit or check a prior authorization request

For DMEPOS services, Carelon Post Acute Solutions will begin receiving requests on Tuesday, June 20, 2023, for dates of service July 1, 2023, and after. 

 

Providers are encouraged to request authorization using NexLync. Go to https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/anthem-provider-resources/ to get started. You can upload clinical information and check the status of your requests through this online tool 24 hours a day, seven days a week. If you are unable to use the link or website, you can call the Carelon Post Acute Solutions Provider Call Center at 844-411-9622 from 7 a.m. to 7 p.m. CT, Monday through Friday, or send a fax to Carelon Post Acute Solutions at 833-311-2986.

 

Please note: Carelon Post Acute Solutions will not review authorization requests for products/services that do not fall under Medicare-covered products/services, such as home infusion, hospice, outpatient therapy, or supplemental benefits that help with everyday health and living, such as personal home helper services offered under essential/everyday extras.

 

To learn more about Carelon Post Acute Solutions and upcoming training webinars, visit https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/anthem-provider-resources/ or email provider_network@carelon.com.

 

If you have additional questions, please call the Carelon Post Acute Solutions Provider Call Center at 844-411-9622.

* Carelon Post-Acute Solutions, LLC is an independent company providing services on behalf of the health plan.
MULTI-BCBS-CR-019705-23