Welcome to the Carelon Behavioral Health of California, Inc. network of participating providers.
As a Knox-Keene Plan, Carelon Behavioral Health of California is regulated by the California Department of Managed Health Care (DMHC). Where there is conflict between Carelon Behavioral Health requirements and Knox-Keene regulations, the Carelon Behavioral Health of California policies and procedures and handbook will reflect the Knox-Keene regulations for Carelon Behavioral Health of California business, if more stringent.
Together, the Carelon Behavioral Health of California provider agreement, addenda, and the handbook outline the requirements and procedures applicable to providers in the Carelon Behavioral Health of California networks. Information specific to participating providers in the EAP network can be found in the EAP Provider Handbook. The handbook is an extension of the provider agreement and includes requirements for doing business with Carelon Behavioral Health of California, including policies and procedures for individual providers, affiliates, group practices, programs and facilities and requirements for maintaining accurate demographic information in the provider directory. It provides important information regarding the managed care features incorporated in the Carelon Behavioral Health of California provider agreements and reflects the policies and procedures that are applicable to our Knox-Keene product lines.
Carelon Behavioral Health of California may, by notice, amend or change any or all provisions of the handbook by providing 45 business days prior written notice to providers unless the amendment is material and not made in order to comply with a change in state or federal law or accreditation standards. Refer to your Carelon Behavioral Health of California participating agreement for information related to handbook or agreement amendments. To the extent that there is an inconsistency between the handbook and the provider agreement, Carelon Behavioral Health of California reserves the right to interpret such inconsistency. Carelon Behavioral Health of California’s interpretation shall be final and binding.
Provider Handbook
EAP Affiliate Handbook
Handbook Glossary
Provider Directory Requirements
Medical Necessity Criteria and Resources
Clinical Practice Guidelines
- World Professional Association for Transgender Health (WPATH)
Carelon Behavioral Health of California Forms
- EAP Statement of Understanding Form
- EAP Statement of Understanding Form (Spanish)
- Primary Care Provider (PCP) Referral Form
- Provider Dispute Resolution (PDR) Request
- Medi-Cal Fee-for-Service Enrollment Form
- Prior Authorization Forms
- CAF-1 EAP Case Activity and Billing Form
- CAF-2 EAP Case Activity and Billing Form
- EAP Case Activity and Billing Form FAQ
Language Assistance Resources
Independent Medical Review (IMR) information in non-English languages is available on the Department of Managed Health Care’s (DMHC) web site:
Independent Medical Review/Complaint Form
Carelon Behavioral Health of California ensures that the standards and mechanisms for providing free language assistance services to members and LEP member language needs information collected by Carelon Behavioral Health of California is available to Carelon Behavioral Health of California participating providers.
