Prior authorization

Carelon prior authorization and recommended clinical review (RCR) for select outpatient services for some BCBSTX members: Blue Choice PPO, Blue Essentials, Blue Premier, Blue Premier Access, Blue Advantage HMO, MyBlue Health, Blue High Performance Network, TRS and ERS participants. Carelon Provider Portal preferred. Fax is only for physicians/professional providers sending clinical information for existing requests. Capitated IPA/medical group providers follow the IPA's process.

Carelon replaced EviCore for some BCCHP (Illinois Medicaid) prior authorizations for dates of service on or after Aug. 1, 2025: genetic testing, medical oncology, radiation oncology, musculoskeletal (spine, joint, pain procedures), radiology and rehabilitation (PT/OT/speech). Code lists are in BCBSIL government-program prior authorization materials. Source is a July 2025 BCBSIL news notice.

Premera says Carelon reviews genetic testing, imaging (CT, echocardiography, MRI, MRA, nuclear cardiology, PET), radiation oncology and sleep study/sleep medicine for applicable members. Register with Carelon and submit online or by phone; same number for questions. Prior authorization isn't required for ER services or inpatient hospitalization (see page).

Carelon manages cardiology, high-tech radiology, in-lab sleep studies (adult Blue Cross commercial members in certain self-funded groups only), medical oncology (URMBT only) and radiation oncology for Blue Cross and/or BCN. Use this number for Blue Cross commercial and Medicare Plus Blue members; requests must go through the number assigned to the plan so they route correctly. FAQ revised September 2026.

Carelon phone line for BCN commercial and BCN Advantage members for Carelon-managed services (cardiology, high-tech radiology, radiation oncology and others per the FAQ). Do not use the Blue Cross commercial/Medicare Plus Blue number for BCN members. FAQ revised September 2026.

Carelon's Contact Center for BCBSMA members whose plans require Carelon review of high-technology radiology; the BCBSMA sleep management page lists the same number for sleep services, and Carelon's BCBSMA genetic testing FAQ lists it for genetic testing. Carelon Provider Portal (providerportal.com) is the online alternative.

Independence contact page: Carelon handles precertification for CT/CTA, MRI/MRA, PET, nuclear cardiology, facility-setting sleep studies, CPAP titration, sleep equipment (APAP, BPAP, CPAP) and supplies, the Cardiology Utilization Management Program and the Musculoskeletal Utilization Management Program. Radiation therapy and genetic testing are with eviCore at a different number.

Louisiana Blue Professional Provider Office Manual (June 2026): use Carelon for high-tech imaging, cardiology, genetic testing, musculoskeletal, radiation oncology and sleep management programs; Louisiana Blue does not perform these reviews. Online via the Carelon MBM Provider Portal or iLinkBlue Authorizations tab.

Carelon genetic testing program FAQ for PacificSource: submit test requests via the ProviderPortal or by calling Carelon. FAQ is an older document posted on Carelon's genetic testing resources page; confirm the program still applies to the member's plan.

Carelon genetic testing prior authorization for UCare members; also the line for urgent genetic testing requests (response within 72 hours). Portal: providerportal.com. Portal technical help is the separate Carelon support line.

CareFirst genetic testing prior authorization FAQ (older document still posted on Carelon's genetic testing resources page; it uses the former AIM name). CareFirst providers can also start requests in CareFirst Direct's Pre-Auth/Notifications tab. Confirm the program is current for the member.