Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

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Current Cardiology Guidelines

The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Carelon Clinical Appropriateness Guidelines for Cardiology are developed through a rigorous process integrating evidence-based literature with expert physician review. Included are guidelines for imaging of the heart, diagnostic coronary angiography, percutaneous coronary intervention, cardiac resynchronization therapy, and implantable cardioverter defibrillators.

The guidelines do not address coverage, benefit or other plan specific issues. Applicable federal and state coverage mandates take precedence over these clinical guidelines. If requested by a health plan, Carelon will review requests based on health plan medical policy/guidelines in lieu of the Carelon guidelines.