Carelon to expand existing prior authorization program, starting Sept. 1

For dates of service on or after Sept. 1, 2023, additional services will require prior authorization by Carelon Medical Benefits Management (formerly known as AIM Specialty Health^®).

Carelon currently manages select services for Blue Cross Blue Shield of Michigan commercial, Blue Care Network commercial, Medical Plus Blue℠ and BCN Advantage℠ members.

Here’s a summary of the changes that will occur starting Sept. 1:

• For both Blue Cross and BCN commercial members, additional cardiology and advanced imaging services will require prior authorization.
• For Blue Cross commercial members, additional sleep study services will require prior authorization.
• For BCN commercial members, Carelon will start managing in-lab sleep studies.

By Aug. 14, the Carelon ProviderPortal^® and the Carelon call center will be ready to accept prior authorization requests for these additional services.

These changes apply to:

• Most Blue Cross commercial members
• All BCN commercial members

For the services that Carelon already manages, you’ll continue to request prior authorization through the Carelon ProviderPortal.

Look for additional details about these changes in upcoming provider alerts and newsletter articles.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.