Carelon Medical Benefits Management clinical appropriateness guidelines and cancer treatment pathways

Home 9 Current General Guideline

Current General Guideline

The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines.

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.


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