Call one of the numbers below between the hours of 8:00 AM – 8:00 PM ET Monday through Friday for more information about for our policies for behavioral health.
Commercial PPO, POS, Comprehensive, and Traditional members Call 866.322.1657
For Commercial HMO, Children’s Health Insurance Program (CHIP) HMO, and Medicare Advantage (BlueJourney PPO and BlueJourney HMO) members Call 800.216.9748
For Federal Employee Program (FEP) PPO members (Facility Only) Call 800.356.7986 for Federal Employee Program (FEP) PPO members (Facility Only)
Medical necessity criteria
We use industry standard clinical management criteria to determine medical necessity.
Providers can request preauthorization through the phone and on-line.
Carelon provides behavioral health management services, including preauthorization requests, for Capital Blue Cross members including Traditional, Comprehensive, PPO, POS, HMO/CHIP HMO, FEP (facility only) and Medicare Advantage.
Providers can call one of the numbers below between the hours of 8:00 AM and 8:00 PM. ET Monday through Friday. Note: Carelon is available 24/7 for preauthorization requests for inpatient levels of care.
Commercial PPO, POS, Comprehensive, and Traditional members Call 866.322.1657
For Commercial HMO, Children’s Health Insurance Program (CHIP) HMO, and Medicare Advantage (BlueJourney PPO and BlueJourney HMO) members Call 800.216.9748
For Federal Employee Program (FEP) PPO members (Facility Only) Call 800.356.7986 for Federal Employee Program (FEP) PPO members (Facility Only)
Providers can use the Carelon Provider Portal for ABA preauthorization requests. The Provider Portal is available 24 hours a day, seven days a week, to provide notification and clinical information as appropriate. Providers can secure copies of the authorization requests at time of submission for their records.
