Carelon Behavioral Health

Carelon Behavioral Health

Carelon Behavioral Health (formerly Beacon Health Options, formerly ValueOptions)

Provider guide for Carelon Behavioral Health, the managed behavioral health organization under Elevance Health serving Anthem members.

Quick Reference

Payer Type

Managed Behavioral Health

Parent Company

Elevance Health (formerly Anthem)

Headquarters

Norfolk, VA

BH Division

Carelon Behavioral Health

Provider Portal

Open Portal

Portal Guide

View Guide →

Credentialing

CAQH ProView

Timeline

60-120 days

Coverage

1 states

Last Verified

Apr 19, 2026

Published

Mar 15, 2026

Reading Time

12 min

Covered Levels of Care

• Detoxification (Medically Managed and Monitored)
• Residential Treatment
• Partial Hospitalization (PHP)
• Intensive Outpatient (IOP)
• Outpatient Treatment
• Crisis Stabilization
• Medication-Assisted Treatment (MAT)

Medical Necessity Criteria

• ASAM Criteria
• InterQual Behavioral Health Criteria
• Carelon Proprietary Clinical Guidelines

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Overview

Carelon Behavioral Health is one of the largest managed behavioral health organizations (MBHOs) in the United States, with its behavioral health operations historically headquartered in Norfolk, Virginia (the legacy Beacon Health Options HQ). It operates as a subsidiary of Elevance Health, the parent company of Anthem Blue Cross Blue Shield health plans. Carelon manages behavioral health benefits for approximately tens of millions of members as of 2025 across commercial employer-sponsored plans, individual plans, Medicare Advantage, and state Medicaid programs.

Carelon Behavioral Health has undergone significant name changes that can cause confusion for providers. The organization was originally known as ValueOptions, then became Beacon Health Options after a merger in 2014. Anthem Inc. announced its intent to acquire Beacon Health Options in 2020 and closed the transaction that same year. Anthem Inc. then rebranded as Elevance Health in June 2022, and Beacon Health Options was rebranded as Carelon Behavioral Health under the Carelon services family in 2023. Providers who previously worked with Beacon Health Options or ValueOptions are now working with Carelon Behavioral Health. Historical authorizations, contracts, and network participation generally carried over through these transitions, but provider portals, contact numbers, and operational workflows have changed.

Like Optum, Carelon operates as a behavioral health carve-out manager. This means that Carelon manages behavioral health benefits not only for Anthem members but also for members of other health plans, employers, and government programs that contract with Carelon for specialized behavioral health management. Providers may encounter Carelon managing authorizations for members whose insurance card shows Anthem, a state Medicaid plan, or another employer or health plan entirely. Understanding that Carelon sits between the provider and the underlying health plan is essential for navigating authorization and claims workflows effectively.

Behavioral Health Coverage

Carelon Behavioral Health administers coverage for a comprehensive range of behavioral health services across the plans it manages. Commonly covered levels of care include medically managed detoxification, medically monitored detoxification, residential treatment, partial hospitalization programs (PHP), intensive outpatient programs (IOP), standard outpatient treatment, crisis stabilization, and medication-assisted treatment (MAT). The specific benefits available to any individual member depend on their underlying health plan’s benefit design.

For medical necessity determinations, Carelon uses a combination of evidence-based clinical criteria. For substance use disorder treatment, Carelon references the ASAM Criteria as the primary framework for level of care placement and continued stay review. For certain medical and behavioral health services, Carelon uses InterQual criteria, a widely used clinical decision support tool. Carelon also maintains proprietary clinical guidelines that supplement these standard criteria for specific service types and populations.

Carelon publishes its clinical guidelines and level of care criteria through the Carelon Behavioral Health provider portal. Providers should review these criteria to understand the specific clinical indicators that Carelon reviewers assess during authorization and concurrent review. Familiarity with the applicable criteria helps ensure that clinical documentation addresses the key decision points and supports the requested level of care. Federal mental health parity requirements apply to the commercial plans Carelon manages, and state Medicaid rules govern parity application for Medicaid programs.

Credentialing and Provider Enrollment

Carelon Behavioral Health uses CAQH ProView as its primary credentialing data source. To begin the credentialing process, maintain a current, fully attested CAQH ProView profile with complete information on licensure, accreditation, malpractice insurance, NPI numbers, taxonomy codes, and service locations. The credentialing timeline typically ranges from approximately 60 to 120 days, depending on the line of business (commercial versus Medicaid) and geographic region, though timelines can vary.

To initiate credentialing, visit the Carelon Behavioral Health provider portal at carelonbehavioralhealth.com/providers to review network participation opportunities and contact provider relations. Carelon evaluates network adequacy by geography, specialty, and line of business before accepting new providers. If network need exists in your area, Carelon will pull your CAQH ProView data and begin the verification process.

Facility credentialing requires documentation of current state behavioral health facility licenses, accreditation from a recognized body (Joint Commission, CARF, or state equivalent), organizational NPI, facility liability insurance, clinical programming descriptions, and organizational structure documents. Carelon may conduct site visits for residential facilities and other facility-based programs. Given Carelon’s multiple lines of business, providers may need to credential separately for commercial, Medicare, and Medicaid products depending on the contracts in their state.

Providers who were previously credentialed with Beacon Health Options generally had their credentials transitioned to Carelon. However, if you are unsure of your current network status, contact Carelon’s provider relations team to verify your credentialing status, contract terms, and network participation across the applicable lines of business. Recredentialing generally occurs on a three-year cycle.

Verification of Benefits (VOB)

Verifying member benefits through Carelon Behavioral Health can be performed through the Carelon provider portal, by phone, or through standard electronic eligibility transactions. The Carelon Behavioral Health provider portal allows registered providers to check member eligibility, view behavioral health benefit details, confirm authorization requirements, and access plan-specific information.

Standard HIPAA 270/271 electronic eligibility transactions through clearinghouses will return basic eligibility status and plan information for Carelon-managed members. For detailed behavioral health benefit information — including specific level of care coverage, visit limitations, authorization requirements, and cost-sharing amounts — the Carelon provider portal or a phone call to Carelon provider services may be necessary.

When verifying benefits, it is important to determine whether Carelon is managing the member’s behavioral health benefits, as this is not always apparent from the member’s insurance card. Members with Anthem plans will frequently have behavioral health carved out to Carelon. Members of state Medicaid programs with behavioral health carve-outs to Carelon will have their behavioral health benefits managed separately from their medical benefits. Ask about behavioral health carve-out arrangements when verifying benefits through any channel.

Document all VOB details thoroughly: verification date, method, representative name, reference number, confirmed eligibility, applicable cost-sharing, covered levels of care, and authorization requirements. Benefits verification does not guarantee payment — authorization, medical necessity, and proper claims submission are still required.

Prior Authorization Requirements

Carelon Behavioral Health requires prior authorization for most facility-based behavioral health services. Services requiring authorization typically include medically managed and monitored detoxification, residential treatment, inpatient psychiatric hospitalization, and in many plans partial hospitalization programs. Authorization requirements for intensive outpatient and outpatient services vary by the underlying health plan.

Authorization requests can be submitted through the Carelon Behavioral Health provider portal, by phone, or by fax. The provider portal supports electronic authorization submission and status tracking. When submitting a request, include comprehensive clinical documentation covering the member’s current diagnosis, presenting symptoms, substance use or psychiatric history, previous treatment episodes, current functional status, risk assessment, medications, and the proposed treatment plan.

For substance use disorder treatment, structure clinical documentation around the ASAM Criteria dimensions and clearly demonstrate why the requested level of care is clinically appropriate. For mental health services, document functional impairment, safety risk, symptom severity, and treatment complexity consistent with Carelon’s clinical guidelines and InterQual criteria where applicable. Explicitly addressing the criteria that Carelon’s reviewers use strengthens authorization requests.

Concurrent reviews are generally required for all residential and inpatient stays, typically approximately every 3 to 7 days depending on the level of care, though intervals can vary. Provide updated clinical documentation showing treatment progress, response to interventions, continued medical necessity, and active discharge planning. If Carelon denies an initial or continued stay authorization, providers receive written notification with the clinical rationale and appeal rights. Peer-to-peer reviews with a Carelon medical director are available and should be requested promptly when you believe additional clinical context would support the authorization.

Claims and Billing

Claims for services managed by Carelon Behavioral Health are submitted to Carelon, not to the member’s underlying health plan (such as Anthem). This is a critical distinction — routing behavioral health claims to Anthem’s general medical claims address when Carelon manages the behavioral health benefit will result in claim rejections or processing delays. Verify the correct Carelon payer ID and claims submission route through the Carelon provider portal or your clearinghouse.

Carelon accepts electronic claims through standard EDI 837 transactions via clearinghouses. Institutional claims use the UB-04/837I format, and professional claims use the CMS-1500/837P format. Electronic submission is strongly preferred. Ensure you are using the Carelon-specific payer ID for behavioral health claims, as Elevance Health and Anthem use different payer IDs for medical versus behavioral health claims processing.

Timely filing deadlines vary by the underlying health plan and your provider agreement. Commercial plans typically allow approximately 90 to 365 days from the date of service. Medicare and Medicaid plans follow their respective regulatory filing requirements. Review your Carelon provider agreement for the specific applicable deadline.

Common denial reasons include missing or expired prior authorization, authorization number not referenced on the claim, incorrect payer ID routing (sent to Anthem instead of Carelon), diagnosis codes not matching authorized services, and member not eligible on the date of service. When claims are denied, review the denial reason code carefully. For billing errors, resubmit corrected claims. For clinical denials, submit appeals with supporting documentation within the timeframes specified in the denial letter. Carelon provides appeal instructions on the Explanation of Payment and denial notifications.

Payer Operations Quick Reference

The single biggest operational trap with Carelon is stale Beacon data. Billing systems, saved contacts, and old contracts full of Beacon Health Options (or ValueOptions) phone numbers, payer IDs, and portal URLs still float around — and some no longer work. Treat any pre-2023 Beacon datum as unverified until you confirm it at carelonbehavioralhealth.com/providers ↗. Legacy context lives on our Beacon Health Options page.

Provider phone numbers

Phone-tree shortcuts are intentionally omitted: we only publish IVR navigation verified first-hand with a date.

Payer IDs and EDI

• Carelon payer IDs are distinct from Anthem’s medical payer IDs and vary by contract/line of business.
• The most common Carelon rejection: behavioral claim sent to the Anthem medical payer ID. Claims for Carelon-managed members go to Carelon, not the underlying plan.
• Re-verify any legacy Beacon payer IDs still configured in your billing system against your clearinghouse list; ERA/ 835 enrollment may also need re-enrollment under Carelon.

Timely filing limits

A misrouted claim (Anthem instead of Carelon) does not stop the filing clock — resubmit to Carelon immediately and keep the rejection evidence. Cross-payer table: /denial-code-timely-filing.

Claims and appeals addresses

• Electronic first: 837P/837I via clearinghouse under the Carelon-specific payer ID; paper addresses are contract-specific — use the authorization letter or portal.
• Appeals: instructions and deadlines are on the EOP/denial letter; request a peer-to-peer with the Carelon medical director promptly for level-of-care denials at detox/residential/PHP/IOP — expedited handling applies during active treatment.

Credentialing contacts

• CAQH ProView ↗ + initiation through the Carelon provider portal; ~60–120 days; recredentialing every 36 months; separate credentialing may be needed per line of business (commercial/Medicare/Medicaid). Beacon-era credentials generally carried over — confirm your current status with provider relations. See insurance credentialing.

Prior-auth quirks for behavioral health levels of care

Operational data last reviewed 2026-06-11; quarterly re-verification cadence applies. Related: Anthem (the largest plan family Carelon serves) and the other “Big Three” MBHOs, Optum Behavioral Health and Magellan. See /rcm for how routes Carelon vs. Anthem claims automatically.

• Detox, residential, and inpatient psych require prior authorization on nearly all Carelon-managed plans; PHP frequently; IOP/outpatient vary by underlying plan.
• Concurrent review cadence: roughly every 3–7 days for residential and inpatient — among the tighter cadences of the major MBHOs.
• Criteria: ASAM for SUD, InterQual for certain services, plus Carelon proprietary guidelines — all published on the provider portal.
• Facility claims bill 837I/UB-04 to Carelon with the authorization number referenced; diagnosis codes must match the authorized service.

Frequently Asked Questions

Carelon Behavioral Health is the current name of the managed behavioral health organization that was previously known as Beacon Health Options and before that as ValueOptions. Anthem Inc. announced its intent to acquire Beacon Health Options in 2020 and closed the transaction that same year; Anthem rebranded as Elevance Health in June 2022, and Beacon Health Options was rebranded as Carelon Behavioral Health under the Carelon services family in 2023. Provider portals, contact information, and some operational processes changed during the transition, though the core functions generally remained similar.

Carelon Behavioral Health is a subsidiary of Elevance Health, the parent company of Anthem Blue Cross Blue Shield plans. Carelon manages the behavioral health benefits for most Anthem commercial and Medicare Advantage plans, similar to how Optum manages behavioral health for UnitedHealthcare. However, Carelon also manages behavioral health benefits for many non-Anthem health plans, employers, and state Medicaid programs that contract with Carelon independently.

Yes, Carelon Behavioral Health holds contracts with multiple state Medicaid programs to manage behavioral health benefits as a carve-out. In these states, Medicaid members may have their behavioral health services authorized and managed by Carelon even though their Medicaid coverage is through a different managed care organization. Providers must check whether behavioral health is carved out to Carelon in their state and follow Carelon's authorization and billing processes accordingly.

Credentialing with Carelon uses CAQH ProView and typically takes approximately 60 to 120 days depending on the line of business and geographic region, though timelines can vary. Ensure your CAQH profile is complete and current. Contact Carelon's provider relations team through the Carelon Behavioral Health provider portal to initiate credentialing and confirm network need in your area. Facility credentialing generally requires state licenses, accreditation, liability insurance, and organizational documentation, though specific requirements may vary.

Carelon generally requires prior authorization for facility-based behavioral health services including residential treatment, detoxification, and inpatient hospitalization, though specific requirements may vary by plan. Requests are typically submitted through the Carelon provider portal, by phone, or by fax. Carelon uses a combination of ASAM Criteria for SUD, InterQual for certain services, and its own proprietary guidelines. Concurrent reviews are generally required for continued stays. Peer-to-peer reviews are typically available when authorization requests are denied.

Carelon does not publish one national provider line — contact numbers vary by the underlying contract (Anthem commercial, state Medicaid carve-out, employer plan). Current numbers are listed after sign-in at carelonbehavioralhealth.com/providers, and the member's ID card or authorization letter carries the contract-specific line. Beware legacy Beacon Health Options numbers in old documentation — verify any saved number against the Carelon portal before calling.

Carelon behavioral health claims use Carelon-specific payer IDs that are distinct from Anthem's medical payer IDs, and they vary by contract and line of business. Confirm the correct ID through the Carelon provider portal or your clearinghouse before submitting — routing a behavioral claim to the Anthem medical payer ID is the most common Carelon rejection. Legacy Beacon payer IDs in old billing configurations should be re-verified.

Timely filing varies by the underlying health plan and your Carelon provider agreement — commercial plans typically allow approximately 90 to 365 days from the date of service, while Medicaid carve-out contracts follow state rules. Your contract is the controlling document; a claim misrouted to Anthem does not stop the Carelon filing clock.

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This guide is provided for informational purposes only and does not constitute legal, regulatory, or professional advice. Payer requirements, phone numbers, and portal URLs are subject to change. Always verify current information directly with the payer. is not affiliated with the insurance companies described on this page.

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