Members

IT’S ALL ABOUT PEOPLE

Our mission is to help people live their lives to the fullest potential. Therefore, everything we do is focused on improving the health of people under our care. Putting people at the center, Carelon Behavioral Health’s system is built on a strong support structure of doctors, nurses, advocates, and mentors fulfilling members’ behavioral, physical, and social health needs.

To learn more about your benefits or to find a provider, click here.

MEMBER RESOURCES

• Authorization for CHIPA to Release Information
• Authorization for CHIPA to Release Information (SPANISH)
• Confidential Communication Request Form (Online)
• Confidential Communication Request Form (Printable)
• Continuity of Care
• Medical Necessity Criteria and Resources
• Member Rights to Request Confidential Communications
• Member Rights and Responsibilities
• Member Rights and Responsibilities (SPANISH)

A COMMUNITY OF SUPPORT

You live in your community, and so do we. By using community resources, we’re able to provide innovative, effective treatments that improve your quality of life along with your health.

AFFIRMATIVE STATEMENT

1. All UM and CM decision making are based only on appropriateness of care and services and existence of coverage. Level of Care Criteria are used as a guideline.
2. There are no financial incentives to encourage adherence to utilization targets and discourage under-utilization. Financial incentives based on the number of adverse determination or denials of payment made by any individual involved in UM decision making are prohibited.
3. CHIPA does not make decisions regarding hiring, compensation, termination, promotion, or other similar matters with respect to any individual based upon the likelihood that the individual will support the denial of benefits.
4. The prohibition of financial incentives does not apply to financial incentives established between health plans and health plan providers.
5. Utilization Management staff in no way rewards or incentivizes, either financially or otherwise, practitioners, utilization reviewers, clinical care managers, physician advisers, or other individuals involved in conducting utilization/case management review, for issuing denials of coverage or service, or inappropriately restricting or diverting care including staff that engage in contracting/network management activities that could potentially influence referrals to specific providers/services.

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OUR MISSION AND VALUES

Mission: We help people live their lives to the fullest potential

Corporate Values: