Payer expertise
Carelon Behavioral Health Billing
What our team handles for you on Carelon behavioral healthcare claims, so your clinical team can stay focused on care.
What our team handles for you on Carelon behavioral healthcare claims, so your clinical team can stay focused on care.
Carelon Behavioral Health (formerly Beacon Health Options) manages behavioral healthcare benefits on behalf of health plans and employers, which means its clinical review and authorization requirements sit alongside, and sometimes differ from, the underlying health plan's own rules. Centerline has billed Carelon-managed behavioral healthcare claims for substance-abuse and mental-health programs for years. We know how their utilization review runs and what their reviewers expect at each level of care.
We confirm the patient's Carelon-managed benefits, the levels of care covered, and Carelon's precertification requirements before the patient is admitted, so nothing is assumed at intake.
For detox, residential, PHP or IOP, we submit the clinical information Carelon needs to authorize the admission at the appropriate level of care.
We track each continued-stay deadline and present the ongoing clinical picture so authorized days aren't lost to a missed or thin review.
If a day or level of care is denied, we appeal and, where available, request a peer-to-peer so your clinician can make the case directly to Carelon's reviewer.
Across the payers we work (Carelon among them), Centerline clients average an 8% increase in authorized patient days. That is a client average reported by Centerline across active engagements, not a guarantee for any specific claim or plan, but it reflects what disciplined utilization review and appeals can protect.
We'll review how your Carelon authorizations, claims and appeals are handled today, and show you exactly where the revenue is leaking.