At BCBSRI, we continue to improve our members’ health and peace of mind by facilitating their access to affordable, high-quality, equitable healthcare.
Currently, BCBSRI performs reviews for skilled nursing facilities (SNF), inpatient rehabilitation facilities (IRF), and long-term acute care hospitals (LTACH). Effective 15 de marzo de 2025, Carelon will be delegated to perform utilization management services for these levels of care for Medicare Advantage members. Carelon’s post-acute utilization management services will include prior authorization, concurrent reviews, and retrospective reviews. These requests will be submitted through the Carelon portal by providers. As a participating provider, you will need to register for the Carelon portal.
All authorization requests for Medicare Advantage members attributed to Prospect will continue to go through Prospect. Prospect can be reached at 1-844-762-9231.
Beginning on 15 de febrero de 2025, Carelon will provide informational sessions designed to orient you and your staff with their services. We encourage the following staff members to attend a session: admissions staff, case managers, discharge planners, nursing directors, therapy directors, social services, and facility administrators. These are self-paced orientation sessions. Each session will last approximately one hour and will cover the following topics:
- Authorization process: SNF, IRF, LTACH
- Clinical documentation requirements
- Portal training
To register for an orientation session, please visit this website:
https://providers.carelonmedicalbenefitsmanagement.com/postacute/provider-materials/
Providers will need this access code to join our self-paced orientation: CMBMRI2025
If you have any questions regarding the Carelon web portal, please contact the web support team via email at PACProvider_Relations@carelon.com.
If you have any additional questions about these changes or webinar registration, please contact Provider Relations at 1-844-707-5627 or ProviderRelations@bcbsri.org.