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Welcome to the Carelon HealthChoices Provider Network. As a Carelon network provider, you join a group of the most respected behavioral health care professionals in the country – individuals who share our commitment to advancing the Commonwealth’s vision of a comprehensive delivery system that assures easy access to quality mental health and substance abuse care. We are pleased to welcome you to the Carelon HealthChoices Behavioral Health Program.

This manual has been developed to answer your questions about the behavioral health component of the HealthChoices Program and to explain how Carelon coordinates the delivery of mental health and substance abuse care to covered individuals. Covered individuals include the Pennsylvania Department of Human Services (DHS) Medical Assistance recipients who are enrolled in HealthChoices. They will be referred to in this manual as “members”.

The manual begins with an introduction to the HealthChoices Program, followed by a listing of services covered under the program. The Carelon workflow process is outlined in its entirety, beginning with referring the member to providers and the authorization of services, to claims submission and payment, as well as assisting with problem resolution. All necessary forms are included in the applicable section for your use or readily available on our Carelon web site. Your adherence to the guidelines presented in this manual will assist Carelon in providing you with timely service authorizations and claims reimbursement.

Kung mayroon kang anumang mga katanungan o komento habang binabasa ang manwal, o sa anumang iba pang oras, mangyaring tawagan ang aming walang bayad na numero ng provider sa 877-615-8503. Ang walang bayad na numero ng provider ay nakalista din sa Makipag-ugnayan sa amin webpage, kasama ang iba pang nauugnay na mga numero ng telepono at impormasyon.

Salamat sa iyong pakikilahok sa aming network ng provider. Inaasahan namin ang isang mahaba at kapwa kapaki-pakinabang na relasyon habang nagtutulungan kami upang magbigay ng tumutugon na paggamot at suporta sa mga miyembro ng HealthChoices.

Mahalagang Paunawa: This manual explains many important aspects of the behavioral health component of the HealthChoices Program. Together, the manual and the Carelon participating provider agreement outline the requirements and procedures that network providers must follow to be included in the Carelon network. Carelon reserves the right to interpret and construe any terms or provisions in this manual and to amend it, at its sole discretion, at any time. To the extent that there is an inconsistency between the manual and the participating provider agreement, the participating provider agreement provisions shall govern.

Carelon is an equal opportunity organization, which does not discriminate on the basis of race, color, sex, national origin, religion, age, disability, or veteran status in admission or access to, or treatment or employment in, its programs and activities.