Request changes to your provider profile

To change your business name, TAX ID or Social Security Number, complete the   Amendment Request Form and return it to amendment_request@carelon.com.  An updated W-9 is required to process this change.

If a TIN or SSN is being added for a new business entity, a new application must be submitted through Availity.com .

To update your demographic information use one of the following methods:

• CAQH (our preferred method)
  • Participating CAQH providers: Log in to your CAQH ProView  
  • New users: Register for CAQH ProView 
     
• The Carelon Provider Portal
  • Log in to our Provider Portal 
  • Select “Update Demographic Information”
     
• National Provider Service Line
  • Call the Carelon National Provider Service Line at 800-397-1630, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.
    

To correct an error in our provider directory, use one of the following methods:

• CAQH (our preferred method)
  • Update your information using CAQH ProView 
     
• The Carelon Provider Portal
  • Log in to our Provider Portal 
  • Select “Update Demographic Information”
     
• National Provider Service Line
  • Call the Carelon National Provider Service Line at 800-397-1630, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.

If you are not accepting new patients, complete the Practice is Full Form Statement and fax it to 866-612-7795.

Our provider services representatives will assist you with this request. Please call our National Provider Service Line at 800-397-1630, Monday to Friday, 8 a.m. to 8 p.m. Eastern time.  

Complete the Leave of Absence form and fax it to 866-612-7795.

To make updates to your current contract, complete an   Amendment Request Form and return it to amendment_request@carelon.com.

Our provider services representatives can assist you with this request.  Please call our National Provider Service Line at 1-800-397-1630 if you have any questions.