Provider Manual


Providers are able to check on the status of their claims and/or address any questions or concerns about claims issues via one of the following methods:

  1. Availity Essentials

    Availity Essentials is a secure, one-stop, self-service claims portal. Beginning on March 1, 2022, Availity Essentials is the preferred multi-payer portal of choice for submitting the following transactions to Carelon:

    • Claim Submissions (Direct Data Entry Professional and Facility Claims) applications or EDI using the Availity EDI Gateway
    • Eligibility & Benefits
    • Claim Status
  2. Carelon Online Provider Services*
    • Go to
    • Click on “For Providers”
    • Next to “Provider Online Services” click “Login”
    • Enter the submitter identification number and password to login
    • Select “Claims Inquiry” to check on the claim status
    • Enter the member’s 9-digit Medical Assistance identification number
    • Enter the member’s date of birth in ‘MM/DD/YYYY’ format
    • Enter the begin date of service in ‘MM/DD/YYYY’ format
    • Enter the end date of service in ‘MM/DD/YYYY’ format

    * In order to be able to access the system, providers must first obtain a User ID and Password by clicking on Register, which is next to the Login button.

  3. Carelon Health of Pennsylvania’s Toll-Free Provider Number

    Call the toll-free provider number at 1-877-615-8503 between the hours of 8:00 a.m. and 5:00 p.m. Eastern Time and a Member and Provider Service Representative will be glad to assist with any claims questions.