REQUESTS FOR AUTHORIZATIONS/RETRO-AUTHORIZATIONS
Upon receipt of a request for authorization for services, by phone, electronic, or fax
transmittal, Carelon has seven (7) calendar days to enter a provider’s authorization.
Providers should be able to access authorizations within two (2) business days of a
decision. An icon will appear on the ProviderConnect home page indicating that new
authorization letters are available. Click on the link on the ProviderConnect home page
to go to links to new authorization letters. Print the letters or save them to your
computer. Only approval letters are electronic. Adverse determination letters and return
of incomplete requests will continue to be sent to providers via US Mail, fax or Provider
Connect.
If, for any reason, the provider finds it necessary to request a retro-authorization for
behavioral health service(s), the request must be received in writing no later than forty-
five (45) calendar days from the date of service. The request for behavioral health
retro-authorization must be faxed to Carelon Health of Pennsylvania (Behavioral Health)
Services (855-439-2444) to the attention of the Clinical Department or mailed to the
attention of:
Carelon Health of Pennsylvania
Clinical Department
P.O. Box 1840
Cranberry Twp., PA 16066-1840
The request for a retro-authorization only guarantees consideration of the request. The
provider will receive written notification within thirty (30) calendar days from Carelon’s
receipt of the request, approving or denying the service. Any requests for retro-
authorization(s) received beyond forty-five (45) calendar days from the date of service
will not be given consideration.
Payment for Retro-Authorizations
If the provider received written approval for the retro-request for service(s) and has not
previously submitted a claim, the provider should follow the procedures as outlined in
the Carelon Provider Manual for submission of claims adjustments, outlined in Section
VI of Claims Payment. The claim must be received by Carelon within ninety (90)
calendar days from the date on the approval letter.
Below is the link to the Retro-Authorization form that needs to be completed and sent to the Clinical Department.