Manual do Provedor


Conforme Apêndice AA of the Balanced Budget Act (BBA) all Managed Care Organizations are required to have a process in place to ensure HealthChoices members are notified as expeditiously as possible of medically necessary services authorized for payment. Carelon posts member-specific authorization letters on ProviderConnect daily. Adverse determination letters and return of incomplete requests will continue to be sent to the provider via US Mail. Due to confidentially concerns surrounding behavioral health services, letters are mailed only to providers. Please make available to all HealthChoices members any Carelon authorization letters pertaining to the member when they present for service.