Provider Manual


Providers must immediately notify the Carelon Engagement Center in writing, to the attention of the Network Management Department, upon the occurrence of any of the following:

  1. Change of address, name change or merger, and/or new tax identification number. Please use either the “Address Update Form” or the “Request for Taxpayer Identification Number Form” when submitting the change. These forms may also be faxed to 1-855-541-5211.
  2. Revocation, suspension, restriction, termination, or voluntary relinquishment of any of the licenses, authorizations, or accreditations required by the Carelon agreement
  3. Any legal action pending for professional negligence which may reasonably be considered to be a material loss contingency, and the final disposition of the action
  4. Any indictment, arrest, or conviction for a felony or for any criminal charge related to an individual’s or a facility’s professional practice
  5. Any lapse or material change in professional liability insurance coverage;
  6. Restriction, suspension, revocation or voluntary relinquishment of medical staff membership or clinical privileges at any healthcare facility
  7. Any condition that results in temporary closure of a facility or office; or
  8. Outbreak of a serious communicable disease

Carelon recognizes that members have a basic right to privacy of their personal information and records. Access to member information lies solely with the member except in the case of a parent or guardian with legal custody of a minor child, or a person with legal authority to act on behalf of an adult or emancipated minor in making decisions related to health care.