Temporary Carelon portal issue for Medicare members

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 Tuesday, January 6, 2026.

For services scheduled on or after January 6, 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 Medicare CPT Code Page on the Blue Cross and Blue Shield of North Carolina (Blue Cross NC) website.

Services rendered between January 1, 2026, and January 6, 2026:

Blue Cross NC will waive the prior authorization requirement and reprocess any affected claims. No action is required from providers.

Please note: This process differs from the Commercial approach due to Centers for Medicare & Medicaid Services (CMS) regulations and our ability to conduct retrospective reviews.

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.