It is available 24/7 giving you access to the following features:
- Eligibility Status
- Claims Search (for specific member(s) and view details of the claim such as claim status, paid date, check number)
- Electronic Claims Submission (both Batch and Single Claim)
- View and Print Correspondence (includes Authorizations)
- Access Your Provider Practice Profile (lookup demographic information, validate and submit changes online)
- Submit Inquiry to Customer Service (send a question to Carelon online and get a response in the manner you choose)
- Benefit Status
- Register Outpatient and Inpatient Care
- Request Authorizations
- Access Provider Summary Vouchers
Call the EDI Help Desk for Help
Carelon EDI Helpdesk staff is available Monday through Friday, 8 a.m. – 6 p.m. EST to walk you through the entire process. Call the EDI Helpdesk at (888) 247-9311 and press option 3.
Know Your Carelon Provider ID
In order to maximize the benefit of using this online service, you will need to have your Carelon unique Provider ID. You may locate your unique Provider ID in the “Welcome letter” you received when joining the Carelon’s network. Your unique Provider ID can also be obtained by calling our National Provider Line at 1-800-397-1630, Monday – Friday, 8:30 a.m. – 5 p.m. EST.
Providers must obtain a User ID before using Online Services. To accomplish this, the following forms must be completed.
Online Services Account Request Form
This form authorizes Carelon to receive and process claims electronically and certifies that claims will comply with all laws, rules and regulations governing your contract with Carelon. Providers who wish to have inquiry-only access to our system for the purpose of conducting eligibility inquiries and claim status inquiries must also submit this form. All online services users must complete this form.
Online Services Intermediary Authorization Form
This form authorizes an external entity such as a billing agent or clearinghouse to submit claims on the provider’s behalf. This form must be completed only if the provider utilizes the services of a billing agency, clearinghouse or other third party.
Software Downloads for Claims Submission:
The EDI (Electronic Data Interchange) Claims Link for Windows® application provides a method for providers or their designated representatives to submit HIPAA compliant electronic claims to Carelon.
- EDI Claims Link for Windows® 3.1 (Application)
- EDI Claims Link for Windows® 3.1 User’s Manual (PDF)
- EDI Claims Link for Windows® 3.1 Quick Start Guide (NOTE: Please read before installing EDI Claims Link 3.1 )
Carelon is also a HIPAA-compliant organization. The links provide additional information regarding submitting electronic HIPAA transactions to Carelon.
- How to Submit Electronic Claims in HIPAA 837 Format
- Behavioral Health Revenue Codes Approved by NUBC
- 270/271 Companion Guide (PDF)
- 276/277 Companion Guide (PDF)
- 278 Companion Guide (PDF)
- 820 Companion Guide (PDF)
- 834 Companion Guide (PDF)
- 835 Companion Guide (PDF)
- 837 Companion Guide (PDF)
- 837 Professional Implementation Guide
- 837 Institutional Implementation Guide
- Special Billing Instructions
- Where to Learn More About HIPAA
- All authorization letters created before 12/31/2009 will be moved to an archive folder. For old letters, call the toll-free Provider Line at 877-615-8503. This enhancement will result in faster searches for authorization letters on ProviderConnect.
- Providers using Internet Explorer 8.0 may experience difficulties when requesting authorizations on ProviderConnect. To resolve these problems, click on the “Tools” menu at the top of your browser; click on “Compatibility View Settings;” type in: valueoptions.com and click the Add button; and click the “Close” button.