Caring for Our Communities
- Caring for Our Communities – How do we pick ourselves up from the ashes of trauma and tragedy? How do we get through the everyday disappointments and setbacks of life? Life will get better, and we need to nurture a vision of how to make it better. Visit these resources for Carelon members and providers alike.
ACT 62 Information
- Autism Coverage – Acceptable Benefit Verification Information
- Carelon ACT 62 Fax Cover Sheet
- Frequently Asked Questions
- ACT 62 Process Change—Effective 8/01/19
- When Does an ACT 62 Packet Need Sent for Authorization Purposes?
Claims Dept
- Appendix AA — Prior Authorization Requirements
- Paper Claims Submission Address: (For new and corrected paper claims) Carelon Pennsylvania Claims P.O. Box 1853 Hicksville, NY 11802-1853
- CMS-1500 Instructions
- CMS Place of Service Codes
- Explanation of Payment (EOP) Codes
- Free Medicare Consumer Workbook
- Frequently Asked Questions from the Member and Provider Service Representative
- ICD-10 Frequently Asked Questions
- National Provider Identifier (NPI) Frequently Asked Questions
- PaySpan Frequently Asked Questions
- PaySpan Payer User Guide
- PaySpan Provider User Guide
- CMS ICD-10 Code Lookup
- Coding Conversion Tool
- UB-04-CMS-1450 Instructions
- Carelon Billing Guide
- Customer Service Audio Recordings (Helpful Tips)
- Carelon Provider Guide to Using Direct Claim Submission
- Carelon Provider Guide to Changing or Reprocessing Professional Claims
- 5010 File Submissions
- Paper Claims Submission Requirements
Clinical / Utilization Management
- Clinical Practice Guidelines
- Auto Auths
- Best Practice Guidelines
- Case Conceptualizations and Treatment Recommendations from a Recovery Perspective
- Case Management Best Practice
- CCASBE 2 (LD) Data Definitions — Initial
- CCASBE 2 (LD) Data Definitions — Re-Evaluation
- Opioid Addiction & Treatment Resources
- Recovery Oriented Methadone (ROM) Phases of Treatment
Quality Management
Provider EnrollmentProvider Enrollment
- Individual Preferred Provider Criteria for Sexual Offender Treatment
- Individual Preferred Provider Criteria for Treatment of Trauma
- Provider Advisory Council
Provider Relations
2022 Annual Provider Education
- About Carelon
- Deficit Reduction Act
- HealthChoices BH Program-Program Standards and Requirements
- Mental Health Advance Directives: Instructions for Providers
- Minimum Documentation Standards
- PROMISe Enrollment Online
- Provider Advisory Council Membership Directory
- Provider Covered Services Grid – HIPAA Compliant
- Re-Enrollment/Revalidation of Medical Assistance Providers
PA DHS/OMHSAS Information
- OMHSAS Bulletin 22-08-Peer Support Services – Revised 12/28/22
- OMHSAS Bulletin 19-02 PROMISe Service Location Enrollment
- MA Bulletin 99-98-12: Accurate Billing for Units of Service Based on Periods of Time (November 17, 1998)
- MA Bulletin 99-97-06: Accurate Billing for Units of Service Based on Periods of Time (September 17, 1997)
- MA Bulletin: Statewide Preferred Drug List Implementation – Effective January 1, 2020
- OMHSAS Policy Clarification #03-16-01: Encounter Coding
- OMHSAS Policy Clarification #01-14-01: Payment for Diagnostic Laboratory Services in Outpatient D&A Clinics
- DHS [55 PA CODE, CHAPTER 5260] Family Based Mental Health Services for Children and Adolescents
- MA Bulletin (99-10-14) Issued/Effective 12-01-10 “Missed Appointments”
- Program Standards & Requirements Appendix BB – DHS/OMHSAS – Regulations and Policies Not Applicable to HealthChoices
County Specific Provider Information
Beaver County
Formularies