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Carelon Behavioral Health is delighted to introduce the new and greatly improved eServices 5.0! In response to requests from providers like you, we have enhanced eServices capabilities, and made it even easier to use. We think you’ll share our excitement about these new features:
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User Account Management
eServices 5.0 now requires that each provider organization have an Account Administrator designated to manage and activate eServices users. Account Administrators will be the provider contract manager or other appropriate manager. New users that sign up will be activated by their Account Administrator, eliminating the need for you to contact Carelon Behavioral Health for activation. Account Administrators will receive an email notification any time a new user signs up, and new registrants will receive an email notification indicating who their Account Administrator is. This means that eServices user account set up is entirely electronic after the Account Administrator is identified and activated.
In addition to activating users, new eServices allows Account Administrators to manage each user’s level of access to the different eServices features. This means that users will be allowed access only to the transactions that their Account Administrator has given them.
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Authorization Request Enhancements (eORFs)
The authorization request feature now includes the ability to save and manage authorizations. Users whose Account Administrator has given them access will be able to review, edit, save and submit all authorization requests created by users in that provider organization. This new feature allows clinical or administrative managers the ability review and edit requests prior to submission to Carelon Behavioral Health, whether they were created by the manager or another staff person.
Authorization submitters now also have the ability to access prior requests and use the information in that request to auto-populate a new request for that member. This feature auto-populates diagnostic and other fields from the prior request into the new request, saving re-entry of unchanged data. Submitters also have the opportunity to edit the pre-loaded data.
Authorization requests submitted through eServices will now receive an email notification when a decision is made on each authorization. Emails will detail the Authorization request ID and the decision only. Users will access the complete record by logging onto eServices.
Finally, the authorization history search has been modified so that users can view an entire year of authorization requests for a member, instead of looking month by month.
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Claims Submission Enhancements
Claim resubmissions and adjustments are now easier than ever through eServices. Simply search a member’s claim history under “Check Claim Status” to find the original claim. Click on “Resubmit” and the new eClaim form will be auto-populated with the original claim data. Make edits where necessary and resubmit your claim.
Reconsiderations can now be submitted online via eServices. Reconsideration submissions can be submitted by finding your member in the Search History and selecting the action “Submit Reconsideration”.
Explanation of Benefits forms, found under “Provider Reports” are now enhanced to include better visual display tools.
Finally, the Check Claim Status feature has been enhanced to provide more data through easier search methods. Now when searching claims history, users can view an entire year of claims submitted for a member, instead of looking month by month. Additionally, providers can check all claims submitted in a particular month in one search, rather than member by member.
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Eligibility and Benefits
Checking member eligibility is now easier and more informative. eServices will display the member eligibility history, along with medically necessary initial visits used, co-pays, and plan type benefits for each member that you look up.
By selecting “Benefits” under the Eligibility/ Benefits tab, users can view all plan type benefits for contracted plans.
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Provider practice information
Providers can update practice information in eServices as necessary:
- Hours, location and other demographic practice data
- Facilities can update clinician information
- Facilities and solo or group practices can enter NPI numbers
- Enter and update clinician specialties and languages
And many more changes to make the transactions clear, easy and simple.
- Provider Handbooks, bulletins and Level of Care Criteria are all accessible via eServices
- Help page includes methods for contacting Carelon Behavioral Health Strategies" and other tools
- Frequently Asked Questions
- Alerts for pressing eServices news
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