We want to inform you of a temporary issue affecting Carelon Medical Benefits Management’s (Carelon) Surgical Program. As of August 11, 2025, a system error has impacted the identification of members requiring prior authorization for surgical procedures. As a result, both the Carelon Portal and call center may incorrectly indicate that prior authorization is not required.
Resolution Timeline:
This issue is actively being addressed and is expected to be fully resolved by Friday, August 15, 2025.
For services scheduled on or after August 15, 2025:
Please re-verify prior authorization requirements via the Carelon Portal before rendering services. A list of procedures included in the Surgical Program can be found on the Commercial Carelon CPT codes page on the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) website.
Services with dates of service prior to August 15, 2025
Temporary Adjustment to Retro Authorization Policy:
To accommodate this issue, Carelon is temporarily extending the retroactive authorization submission window:
- Effective August 15, 2025, services rendered on or after August 11, 2025, may be submitted for retroactive authorization.
- This extended submission period will remain in effect for 30 days from the date of this notice.
We appreciate your understanding and cooperation as we work to resolve this issue.
For assistance or to initiate a retroactive authorization request, please contact Carelon at (866) 455-8414.
