To request authorization for all levels of care listed above, providers are requested to call the Engagement Center and present the required clinical and demographic information. When contacting Carelon for preauthorization, please follow the instructions for conveying clinical and demographic information outlined in the following section, “Information Required for Service Authorization”. These instructions are presented in order, according to the sequential screens of our on-line care management system. Presenting clinical information in this fashion to our Service Managers will result in timely, effective responses to providers’ requests for authorizations.
At the time of the initial authorization, the Service Manager will provide specific instructions to the treating provider for initiating the concurrent review process. Providers should call the toll-free provider number (877-615-8503) on the last covered day to conduct a concurrent review with the Service Manager. Providers will be notified in writing (and telephonically at the time of the review) of the last covered day for payment. If Carelon was not contacted on the last covered day to do a concurrent review, an administrative denial will be rendered.
要批准对住院和其他级别护理的继续住宿请求，治疗团队成员必须出示该成员当前的体征和症状，并向服务经理提供有关该成员对继续护理的临床需求的详细信息，包括（如果适用） PCPC 和ASAM信息。请参阅以下部分中的“服务授权所需的信息”。