Carelon Important Billing Reminders- Aetna Medicare

Carelon provides authorization for skilled services, Home Health Aides & MSW's for Aetna Medicare patients in Florida. LPN & assistant visits are included in those authorizations. The agency is responsible for assigning the appropriate clinician for the service.

Your billing team then submits the correct HCPC code based on who performed the services.Any questions please contact your MCCA liaison.

Effective January 1, 2024, all Carelon claims will be submitted through Availity. Carelon's payer ID will stay the same. After January 1st you will not be able to submit paper claims. You can still use your clearinghouse, but they will need to connect to Availity's EDI gateway, or you can submit directly through Availity and not use a third-party.

Carelon also sent a reminder that date changes are not necessary for visits completed within a certification period. The authorized visits can be used whenever during the certification period.

Carecentrix Non-routine supplies and Prior Authorization

A friendly reminder regarding routine & non-routine supplies: review your contracts for the reimbursement rate of non-routine supplies. Non-routine supplies are defined as necessary treatment of specific patients. If they are specifically ordered by a physician or are essential to effectuate the plan of care, are not considered routine supplies. Per the agreement, if routine supplies are utilized in greater quantities, they may be billed as payable non-routine supplies, when medically necessary and you have received authorization.

Registration/ Pre-notification is required for all services arranged through CareCentrix. Prior authorization is only required for certain codes.

Please make sure you visit the CareCentrix or MCCA portal to review the prior authorization tool.



Carecentrix is hosting a webinar to keep you up to date. Information can be found on the CareCentrix home page under News Flash.