Carelon Prior Authorization: Portal, Phone Numbers and Guidelines

Carelon reviews advanced imaging, cardiology and other services for Anthem and other health plans. Requests go through the Carelon provider portal.

How the guidelines work

• Carelon guidelines are organized by condition rather than by procedure code: each condition lists the studies considered appropriate and the criteria for them.
• Guidelines are web pages with the effective date in the address, and the current radiology set includes brain, head and neck, spine, chest, abdomen and pelvis, extremities, heart, vascular, oncologic, nuclear medicine and SPECT.
• For a member-specific question, call the number on the patient's ID card; the portal support line handles portal problems only.

Plans covered on this site that use Carelon

• Anthem BCBS: Anthem plans use Carelon Medical Benefits Management for advanced imaging review. Requirements differ by state and plan, so start from Anthem's prior authorization page for the member's state.

Before you submit

1. Look up the study by CPT code on this site to see which guideline sections apply and the conditions they cover.
2. Read the current version of that section on the reviewer's site; the effective date is on the document.
3. Make sure the clinical notes cover what the section asks for: symptoms and duration, exam findings, earlier imaging, treatments tried and the response.
4. Submit on the portal with the CPT and ICD-10 codes matching the notes.
5. If denied, the letter will cite a section code. Answer that section directly in the appeal or peer-to-peer call.

Checked against providers.carelonmedicalbenefitsmanagement.com on September 29, 2026.