Carelon Medical Benefits Management, Inc. updates effective September 1, 2024

Effective September 1, 2024, Simply and CHA will transition to the following Carelon Medical Benefits Management, Inc. Clinical Appropriateness Guidelines for medical necessity or clinical appropriateness reviews for requested interventions. This article is to communicate the plan adoption of these Carelon Medical Benefits Management guidelines. Existing prior authorization requirements have not changed. In the event a prior authorization requirement or site of care review requirement for these services will be implemented, a separate notice will be distributed before the addition of any such prior authorization or site of care review requirement:

• Site of Care Guidelines:
1. Site of Care for Advanced Imaging
2. Rehabilitative Site of Care
3. Surgical Site of Care

Please share this notice with other members of your practice and office staff.