- Braven Health℠Braven Health℠
- Braven Health Supportive Program
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- Cardiovascular Program
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- Surgical and Implantable Device Management Program for Cardiac Surgeries Frequently Asked Questions Updated: March 25, 2021
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- eviCore HealthCare eviCore HealthCare
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- Medical Information Requirements for Programs Administered by eviCore
- Medical Necessity Determination (MND) Review of Molecular and Genomic Diagnostic Testing Services Frequently Asked Questions
- Molecular and Genomic Testing Procedure Codes
- Musculoskeletal Program for Pain Management Services
- Radiation Therapy Program Radiation Therapy Program
- Medical Information Requirements for Programs Administered by eviCore
- Radiation Therapy Program Questions and Answers
- Radiology/Imaging Services Radiology/Imaging Services
- 72 Hour Rule
- Appropriate Use of Modifier 26
- Contrast Agents and Radiopharmaceuticals Contrast Agents and Radiopharmaceuticals
- Contrast Agents and Radiopharmaceuticals
- Codes Considered Inclusive to an Imaging Service
- Codes are Active/Invoice is Required
- Maternal Fetal Medicine Evaluation Coding
- Medical Information Requirements for Programs Administered by eviCore
- Radiology/Imaging Guidelines for Emergency Room Preliminary Reads (Wet Reads)
- Radiology/Imaging Program Guidelines for Use of Modifier 59
- Submitting First Level UM Appeals for Braven Health℠ Members
- Submitting First Level UM Appeals for Horizon Commercial and ASO members
- Correct Coding Rules Bank for Radiology, Cardiology and Ultrasound Services Correct Coding Rules Bank for Radiology, Cardiology and Ultrasound Services
- Correct Coding Rules Bank
- Code Pairs Added to this List - 2024
- Code Pairs Removed from this List - 2024
- Code Description Changes
- Code Bundling Rules Code Bundling Rules
- Code Bundling Rules for Radiology, Cardiology and Ultrasound Services
- Code Bundling Rules for PET/MRI Services
- Value-Based ProgramsValue-Based Programs
- Quality vs. Fee for Service
COVID-19
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Carelon℠ Medical Benefits Management (formerly AIM Specialty Health®) is a specialty benefits management company that supports Horizon by performing Prior Authorization/Medical Necessity Determination (PA/MND) reviews for certain services to be provided to members enrolled in participating self-insured employer group health plans administered by Horizon.
As part of these programs, Carelon reviews provider requests for services against evidence-based guidelines for medical necessity to:
- Engage members and help them make informed health care decisions.
- Help improve the clinical appropriateness of services through the application of evidence-based guidelines.
- Maximize our network’s value through a range of solutions, including assessment tools, cost and quality transparency and reporting.
If you have questions about who to contact for the pre-service review of anticipated services, check the member's ID card or call Carelon at 1-866-766-0250.
Groups Enrolled With Carelon
Through participation in the programs below, Carelon helps to manage the services that are provided to members enrolled in the noted National Account self-insured employer groups.
- Cardiovascular Program
- Diagnostic Imaging Program
- Sleep Disorder Management Program
- Musculoskeletal Program
- Oncology Program
| Account Name | Group Number | ID Card Prefix(es) | Program Participation |
|---|---|---|---|
| Advansix | 76323 | D7V | 1, 2, 3, 4, 5 |
| Alcon | 76115 | B9R, F9W, B5T | 1, 2, 3, 4 |
| Atlas Copco | 76053 | LSH | 1, 2, 3 |
| BASF | 75883 | HBX | 1, 2, 3, 4 |
| BASF | 75906 | HBX | 1, 2, 3, 4 |
| BASF | 76127 | HBX | 1, 2, 3, 4 |
| Catalent | 76319 | C9U, C9Q, C9K, C9J, C9V, C9L | 1, 2, 3, 4, 5 |
| Catalent | 76320 | C9U, C9Q, C9K, C9J, C9V, C9L | 1, 2, 3, 4, 5 |
| Chubb | 76201 | CBZ | 1, 2, 3 |
| DSM | 75993 | DSX | 1, 2, 3, 4 |
| DSM | 76266 | DSX | 1, 2, 3, 4 |
| ECMS | 76351 | J7U | 1, 2, 3, 4 |
| Honeywell | 76118 | NSJ | 1, 2, 3, 4 |
| LES | 76160 | LES | 1, 2, 3 |
| Merck | 76016 | MKY, DUG | 1, 2, 3, 4 |
| Merck | 76017 | MKY, DUG | 1, 2, 3, 4 |
| Merck | 76091 | MKY, DUG | 1, 2, 3, 4 |
| Merck | 76092 | MKY, DUG | 1, 2, 3, 4 |
| Merck USW 1086 | 76086 | LWR | 1, 2, 3 |
| Novartis | 75994 | NVP, NVY, LZU | 1, 2, 3 |
| Novartis | 76048 | NVP, NVY, LZU | 1, 2, 3 |
| Novartis | 75995 | NVP, NVY, LZU | 1, 2, 3 |
| Organon | 76331 | D7W, D7U | 1, 2, 3, 4 |
| Organon | 76332 | D7W, D7U | 1, 2, 3, 4 |
| Pfizer | 76111 | PFR | 1, 2, 3, 5 |
| Pfizer | 76110 | PFR | 1, 2, 3, 5 |
| Sanofi | 76089 | SRA | 1, 2, 3, 4, |
| Sanofi | 76090 | SRA | 1, 2, 3, 4 |
| Signify | 76255 | OUR | 4 |
| Suburban Propane | 75943 | SUB | 1, 2, 3 |
| TD Bank | 76212 | TQT, TQW, TZF, TVV, TQL, TUV, TYN, TUL | 1, 2, 3 |
| TD Bank | 76213 | TQT, TQW, TZF, TVV, TQL, TUV, TYN, TUL | 1, 2, 3 |
| TD Bank | 76214 | TQT, TQW, TZF, TVV, TQL, TUV, TYN, TUL | 1, 2, 3 |
| Trane Technologies | 75849 | HAM, HAQ, IRA | 1, 2, 3 |
| Trane Technologies | 75850 | HAM, HAQ, IRA | 1, 2, 3 |
| Trane Technologies | 76125 | HAM, HAQ, IRA | 1, 2, 3 |
| Verisk | 76321 | KPU | 1, 2, 3 |
| Wood Mackenzie | 76353 | J6V | 1, 2, 3 |
The employer group content above was revised last on April 29, 2024 and may be subject to change.
Carelon℠ Medical Benefits Management has contracted with Horizon Blue Cross Blue Shield of New Jersey for the administration of specialty benefits management. Carelon Medical Benefits Management is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.
