Carelon’s Credentialing Process: Ensuring Quality and Compliance

Carelon’s credentialing process is designed to ensure that all providers meet high

standards of care and comply with relevant regulations. This process involves several

key steps:

1. Application Submission: Providers must complete an online application form,

selecting the appropriate provider type (solo practitioner, group practice, or

facility). For large, multi-state, or national provider groups, a specific network

request form is required. (carelonbehavioralhealth.com)

2. Verification of Credentials: Carelon verifies various aspects of a provider’s

professional background, including: pa.carelon.com+1reddit.com+1

• Education and training
• Licensure and certifications
• Work history and malpractice insurance
• Criminal background checks

Providers are encouraged to register with the Council for Affordable Quality Healthcare

(CAQH) to streamline this process.

3. Site Evaluation: For high-volume practitioners and organizational providers,

Carelon conducts a structured site visit to assess compliance with operational

and clinical standards. (pa.carelon.com)

4. Approval and Contracting: Upon successful credentialing, providers receive a

contract through Carelon’s secure application system. It’s essential to review and

Sign this contract promptly to commence

Services. (providerconnect.carelonbehavioralhealth.com+2levelaheadaba.com+2c

arelonbehavioralhealth.com+2)