Carelon Resources for ProvidersĬarelon Medical Benefits Management is an independent company providing select services to Premera Blue Cross and Premera Blue Cross Blue Shield of Alaska providers. If you have questions, call Carelon at 86. In addition, servicing providers must submit ordering/referring provider information, per guidelines from theĬenters for Medicare and Medicaid Services (CMS), in boxes 17 and 17b on CMS-1500 forms. Servicing providers are strongly encouraged to verify that the prior authorization has been received before scheduling and performing services. Prior authorization isn't required for the following: To request a prior authorization, register with Carelon and then submit your request online or by phone at 86. Imaging (CT scan, echocardiography, MRI, MRA, nuclear cardiology, PET scan)Ĭode list to see which codes require review.Ĭarelon Clinical Appropriateness Guidelines.The following services are subject to review by Carelon: It determines medical necessity, treatment appropriateness, and setting via nationally recognized guidelines. Prior authorization is based on member benefits and eligibility at the time of service. Providers must make prior authorization requests through Carelon for members on plans that require it. Prior authorization is required for certain procedures and services.Ĭontracted providers are financially liable for providing services that are medically unnecessary. Product Development: Overseeing the creation of new products or improvement of the performance, cost, or quality of existing products to achieve business goals.AIM Specialty Health is officially changing its name to Carelon Medical Benefits Management on March 1, 2023.Ĭarelon Medical Benefits Management (formerly AIM) manages prior authorization for select services for Premera Blue Cross.Leadership: Knowledge of and ability to employ effective strategies that motivate and guide other members within our business to achieve optimum results.Agile: Agile is a development process where feedback is continuously gathered from users to create the best user experience.Analysis: Analysis is the process of considering something carefully or using statistical methods in order to understand it or explain it.To maximize the impact and benefits to an organization, Product management must be an independent function separate on its own. The role of product management spans many activities from strategic to tactical and varies based on the organizational structure of the company. The product manager is often responsible for analyzing market conditions and defining features or functions of a product and for overseeing the production of the product. Product elimination begins with the identification of elimination candidates, proceeds with the consideration of remedial actions, continues with a projection of the impact on the business as a whole if a candidate product is eventually eliminated, and concludes with the implementation stage, where management determines the elimination strategy for an item. AIM is a non-profit health plan, serving over 68 million members in 50 states, the District of Columbia, and US territories to ensure they receive optimal health care through evidence-based clinical guidelines and real-time decision support. Product management also involves elimination decisions. Specialty health care is delivered in an appropriate, safe and affordable manner by AIM Specialty Health. The role may consist of product development and product marketing, which are different (yet complementary) efforts, with the objective of maximizing sales revenues, market share, and profit margins. It provides product information for companies and their extended supply chain enterprise. Similarly, product lifecycle management (PLM) integrates people, data, processes and business systems. Product Management: Product management is an organisational lifecycle function within a company dealing with the planning, forecasting, and production, or marketing of a product or products at all stages of the product lifecycle.What Skills Does a person Need at Aim Specialty Health?Īt Aim Specialty Health, specify the abilities and skills that a person needs in order to carry out the specified job duties.Įach competency has five to ten behavioral assertions that can be observed,Įach with a corresponding performance level (from one to five) that is required for a particular job.
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