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Sleep Disorder Management Program

Carelon℠ Medical Benefits Management (Carelon) manages a Sleep Disorder Management Program to certain self-insured employer group health plans administered by Horizon. The program helps health care professionals manage sleep disorder complexities.

The Carelon Sleep Disorder Management Program can help members make more informed decisions regarding their care for sleep testing and therapy. This program is designed to:

  • Improve the clinical appropriateness of sleep therapy testing and services
  • Help members find the highest value place of service for testing and therapy
  • Monitor and manage patient compliance of sleep therapy

Prospective Clinical Case Review

The following services are included in the program:

  • Home sleep test (HST)
  • Initial treatment order (APAP, CPAP, BPAP)
  • In-lab sleep study (PSG, MSLT, MWT)
  • Ongoing treatment order (APAP, CPAP, BPAP)
  • Oral appliances
  • Titration study

This program pertains to both new and existing sleep therapy patients.

Providers should contact Carelon (see below) to obtain an order number before scheduling or performing any elective outpatient home-based (unattended) diagnostic study or a facility-based diagnostic or titration study (free-standing or hospital) as well as for sleep treatment equipment and related supplies.

Services performed in conjunction with Emergency Room services, inpatient hospitalization or urgent-care facilities are excluded. Both ordering physicians (those referring the member for sleep testing) and servicing health care professionals (those free-standing or hospital labs that perform sleep testing) may submit requests.

To submit a request, sign in to the Carelon Provider Portal. You may also call Carelon at 1-866-766-0250, then press 1, weekdays, from 9 a.m. to 6 p.m., Eastern Time (ET). Please reference the Sleep Disorder Management order entry worksheets before submitting your request. These resources are available on the Provider Portal under Sleep Management.

For More Information

Helpful information, guidelines and order entry worksheets are available on the Carelon Provider Portal.

For general information about Carelon, call 1-847-564-8500, weekdays, from 9 a.m. to 6 p.m., ET.

Carelon℠ Medical Benefits Management supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty benefits management. Carelon Medical Benefits Management is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.