We want to inform you of a temporary issue affecting Carelon Medical Benefits Management (Carelon) programs. As of January 1, 2026, a system error has impacted the identification of members participating in Carelon programs that require prior authorization for certain services. As a result, both the Carelon Portal and Carelon 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 as of Thursday, January 8, 2026.

For services scheduled on or after January 8, 2026:

Please re-verify prior authorization requirements via the Carelon Portal before rendering services. A list of procedures included in the Carelon programs 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 rendered between January 1, 2026, and January 8, 2026:

Temporary adjustment to retro authorization policy:

To accommodate this issue, Carelon is temporarily extending the retroactive authorization submission window:

• Effective January 1, 2026, services rendered on or after January 1, 2026, 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 or access the Carelon provider portal via Blue e.