Our powerful specialty benefits platform powers evidence-based clinical solutions that span the specialized clinical categories where a health plan has chosen to focus. In partnership with health plans, we are fully committed to achieving their goals – and yours – to improve health outcomes and reduce costs. Monitor and manage patient compliance with sleep therapy.Ĭarelon collaborates with health plans to help improve health care quality and manage costs for some of today’s complex tests and treatments, working with physicians like you to promote patient care that’s appropriate, safe, and affordable.Improving the clinical appropriateness of sleep testing and therapy through the application of evidence-based guidelines in an efficient and effective review process.Your practice can benefit from participation in several ways, including: ![]() How does the program benefit my practice and patients? ![]() Claims submitted for sleep testing and therapy services performed on or after the effective date will not be paid if has not been obtained through the Carelon Sleep Management Program. Your participation is required when requesting sleep testing and therapy services for your health plan’s members. Servicing physicians’ claims and durable medical equipment (DME) providers’ claims for equipment and supplies will adjudicate based on the approval or denial outcome. Prior authorization will also be required for any subsequent testing and therapy, both initial and ongoing.įor therapy services, members must meet usage criteria for the continued rental of equipment and replacement of supplies. This program will consider the medical necessity of the sleep study as well as the clinical appropriateness of a facility test or a test done in the home. The Sleep Program requires prospective clinical review of non-emergency, non-inpatient sleep testing and therapy services. This program will be administered by Carelon. ![]() We promote the most appropriate use of specialty care services through the application of widely accepted clinical guidelines delivered via an innovative platform of technologies and services. Our mission is to help ensure health care services are more clinically appropriate, safer, and more affordable. Who is Carelon Medical Benefits Management? How will the program be administered?Ĭarelon is a leading specialty benefits management company with more than 25 years of experience and a growing presence in the management of radiology, cardiology, genetic testing, oncology, musculoskeletal, sleep management, surgical, and rehabilitation.
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