Anthem BCBS BH Denial Recovery — 2026 Elevance/Carelon Playbook
Anthem BCBS (14 Blue plans + Amerigroup Medicaid) transitioned BH admin to Carelon Behavioral Health post-Elevance rebrand. Multi-state operators serving Anthem members navigate legacy Beacon PA numbers + new Carelon claim submissions concurrently.
Common Anthem/Carelon BH Denials 2026
- Legacy Beacon PA vs Carelon claim submission cross-reference errors
- 90837 downcoding to 90834 (systematic)
- Continued residential day 5-14 denials
- PHP/IOP visit-cap denials
Anthem/Carelon Appeal Framework
Availity portal or paper appeal → peer-to-peer → external IRE → MHPAEA parity complaint.
Full Optum vs Beacon vs Carelon comparison · Free audit
– KD, Revenant Care