Carelon medical benefits management (formerly AIM)
Carelon manages prior authorization for LifeWise select services.
Prior authorization is required for certain procedures and services. Contracted providers are financially liable for providing services that are medically unnecessary. Providers must make prior authorization requests through Carelon for members on plans that require it.
Prior authorization is based on member benefits and eligibility at the time of service. It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines.
Medical services subject to Carelon review
Check out our code list to see which codes require review, or sign in to use our prior authorization tool. View the Carelon clinical appropriateness guidelines (updated twice yearly).
To request an order number, register with Carelon Online and submit your request online or by phone at 866-666-0776.
Services that don’t require order numbers
- Emergency room services
- Inpatient hospitalization
- Outpatient surgeries (hospitals and free-standing surgery centers)
- Observation stays
Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. In addition, imaging servicing providers must submit ordering/referring provider information, per guidelines from the Centers for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms.
If you have further questions, call Carelon at 866-666-0776.
Carelon Medical Benefits Management is an independent company providing select services to LifeWise Health Plan of Washington providers.