Medical benefits management provider resources
Access portals, tools, and guidelines to submit and manage clinical reviews.
Making the right care easier to deliver
Carelon Medical Benefits Management (MBM) combines evidence-based clinical guidelines with digital tools that simplify prior authorization and utilization review for specialty and post-acute care providers.
With 24/7 portal access, real-time determinations for most case reviews, and transparent criteria, you can manage reviews with greater clarity, speed, and consistency.
Carelon MBM provider portals and resources
Specialty care
Specialty care provider portal
Submit a new prior authorization request, track the status of an existing case, or verify patient eligibility for specialty care services.
Clinical guidelines and pathways
Review our clinical appropriateness guidelines and cancer treatment pathways.
Post-acute care
Post-acute care provider portal
Submit prior authorization requests or check the status of existing cases for home health, DMEPOS, PAC-IM, SDoH, and wound care services.
Post-acute care provider resources
Discover important updates and additional resources for care providers.
Provider Connections
Provider Connections news blog
Access additional resources, microsites for specific conditions, and updates from Carelon Medical Benefits Management.
Frequently asked questions
Built with providers. Backed by evidence.
Effective medical benefits management starts with clinical integrity.
Our guidelines are developed and refined in collaboration with practicing physicians and specialty experts, informed by real-world care and evolving medical research. From criteria development to peer-to-peer consultation when additional utilization review is needed, clinical insight guides each step. This helps ensure decisions reflect current standards and individual patient needs.
We aim to build a review process that reflects your standards, supports your clinical judgment, and advances appropriate care.