Provider Manual


Following these instructions will assist Carelon in processing your claim in an efficient timeframe.

I. Electronic Media Claims Submission Requirements

A provider can submit claims electronically in the following ways:

  1. Availity Essentials
  2. Direct Claims Submission within ProviderConnect (outpatient claims only)
  3. Practice Management Software
  4. Programming Custom File

To access ProviderConnect, visit To obtain a User ID, click on register, complete the required form, and click on “submit”.

If using your own software or a billing service, please contact the EDI Helpdesk. They can be reached at 888-247-9311 to obtain an application to submit EDI. The software must meet National Standard Format. An EDI specialist will work with you to ensure that your software is compatible for billing Carelon.

For providers interested in submitting claims electronically, please refer to “Going Online with Carelon”.

II. Paper Claims Submission Requirements

In the event paper claims must be used, claims for services must be submitted on one of the two National Industry Standard billing forms: the Center for Medicare and Medicaid Services Claim Form CMS-1500 (formally known as HCFA-1500) or the Uniform Billing Form UB-04/CMS-1450.  Claims should be mailed directly to the following address. This address may also be used for corrected claims and adjustments for all counties:

Pennsylvania Claims
P.O. Box 1853
Hicksville, NY 11802-1853