The foundation of our solution platform for specialty benefits management is our clinical appropriateness guidelines. Carelon Clinical Appropriateness Guidelines for Surgical procedures are developed through a rigorous process integrating evidence-based literature with expert physician review. Included are guidelines for surgical site of care and upper gastrointestinal endoscopy.

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.