Provider Handleiding

Welkom

Welcome to the Carelon HealthChoices Provider Network. As a Carelon network provider, you join a group of the most respected behavioral health care professionals in the country – individuals who share our commitment to advancing the Commonwealth’s vision of a comprehensive delivery system that assures easy access to quality mental health and substance abuse care. We are pleased to welcome you to the Carelon HealthChoices Behavioral Health Program.

This manual has been developed to answer your questions about the behavioral health component of the HealthChoices Program and to explain how Carelon coordinates the delivery of mental health and substance abuse care to covered individuals. Covered individuals include the Pennsylvania Department of Human Services (DHS) Medical Assistance recipients who are enrolled in HealthChoices. They will be referred to in this manual as “members”.

The manual begins with an introduction to the HealthChoices Program, followed by a listing of services covered under the program. The Carelon workflow process is outlined in its entirety, beginning with referring the member to providers and the authorization of services, to claims submission and payment, as well as assisting with problem resolution. All necessary forms are included in the applicable section for your use or readily available on our Carelon web site. Your adherence to the guidelines presented in this manual will assist Carelon in providing you with timely service authorizations and claims reimbursement.

Mocht u tijdens het lezen van de handleiding of op enig ander moment vragen of opmerkingen hebben, bel dan ons gratis telefoonnummer op 877-615-8503. Het gratis providernummer staat ook vermeld op het Neem contact op webpagina, samen met andere relevante telefoonnummers en informatie.

Bedankt voor uw deelname aan ons providernetwerk. We kijken uit naar een lange en wederzijds lonende relatie terwijl we samenwerken om responsieve behandeling en ondersteuning te bieden aan HealthChoices-leden.

Belangrijke mededeling: This manual explains many important aspects of the behavioral health component of the HealthChoices Program. Together, the manual and the Carelon participating provider agreement outline the requirements and procedures that network providers must follow to be included in the Carelon network. Carelon reserves the right to interpret and construe any terms or provisions in this manual and to amend it, at its sole discretion, at any time. To the extent that there is an inconsistency between the manual and the participating provider agreement, the participating provider agreement provisions shall govern.

Carelon is an equal opportunity organization, which does not discriminate on the basis of race, color, sex, national origin, religion, age, disability, or veteran status in admission or access to, or treatment or employment in, its programs and activities.