INSURER FILING GUIDE
Carelon Behavioral Health, generic member route for employer carve-outs
Use this public information to prepare your packet, then confirm the route on the insurer's own page.
AT A GLANCE
Claim facts
| Member form | Mental Health / Substance Abuse Treatment Claim Form Number: Not published by the insurer Revision: Not published by the insurer Open the insurer form |
|---|---|
| Portal upload | YES |
| Portal path | Step 1 download and fill the claim form > Step 2 complete the Online Claim Form > enter Member ID, Member Name, Phone Number, Email, and Member Employer > upload up to three files > Submit |
| Mail address | PLAN-DEPENDENT: Reference the member's identification card; the claims submission address may vary based on payment location. |
| Fax | Not published by the insurer |
| Attachments | Patient, subscriber, and employer identifiers; other coverage and Medicare facts; diagnosis; employment or accident facts; dates and place of service; procedure, description, diagnosis pointer, units, and charges; provider identity, tax ID or NPI, address, and credentials; totals and amount paid |
| Deadline | Not published by the insurer |
| Outcome and status | EOB; Member Services if no EOB has arrived after 30 days |
| Processing time | Not published by the insurer: contractual turnaround varies; public FAQ gives a 30-day follow-up threshold |
| Caveats | Generic employer carve-out route only. Employer-specific benefits, filing deadline, appeal route, and claim destination control. The linked form retains obsolete ICD-9 and DSM-IV references, so current coding requirements are Not published by the insurer |
STEP BY STEP
Filing steps
Source: https://ets.valueoptions.com/OnlineClaimSubmission/members/forms/files/Claims_Form.pdf
Read date: 10-09-2026
Research steps
- Confirm the employer plan uses Carelon and that a nonparticipating provider has made the member responsible for filing. Employer-specific rules control. https://ets.valueoptions.com/OnlineClaimSubmission
- Download and complete the Mental Health / Substance Abuse Treatment Claim Form. Complete Part I and have Part II completed as fully as possible. A provider custom claim form may be attached, but Part I and Part II Box 7 remain required. https://ets.valueoptions.com/OnlineClaimSubmission/members/forms/files/Claims_Form.pdf
- In MemberConnect Online Claims Submission Portal, enter Member ID, Member Name, Phone Number, Email, and Member Employer. https://ets.valueoptions.com/OnlineClaimSubmission
- Upload up to three files, no more than 10 MB each. The page validation rejects
.exe,.bat,.com, and.vbs. Click Submit. https://ets.valueoptions.com/OnlineClaimSubmission - If the provider was already paid and payment should remain with the member, do not sign the optional assignment-to-provider line. Complete the separate required member certification. https://ets.valueoptions.com/OnlineClaimSubmission/members/forms/files/Claims_Form.pdf
- NOT PUBLISHED: a successful-submission confirmation, generic filing deadline, or fixed processing time. If no EOB arrives within 30 days, Carelon's public FAQ says to contact Member Services. https://plan.carelonbehavioralhealth.com/wp-content/uploads/FAQs.pdf
Filing facts
- Portal upload: YES
- Portal: MemberConnect Online Claims Submission Portal
- Portal path: Step 1 download and fill the claim form > Step 2 complete the Online Claim Form > enter Member ID, Member Name, Phone Number, Email, and Member Employer > upload up to three files > Submit
- Mail address: PLAN-DEPENDENT: Reference the member's identification card; the claims submission address may vary based on payment location.
- Fax: NOT PUBLISHED
- Attach: Patient, subscriber, and employer identifiers; other coverage and Medicare facts; diagnosis; employment or accident facts; dates and place of service; procedure, description, diagnosis pointer, units, and charges; provider identity, tax ID or NPI, address, and credentials; totals and amount paid
- File types: All except .exe, .bat, .com, and .vbs according to page validation
- File size limit: 10 MB per file
- Maximum files: 3
- One file or separate files: MULTIPLE
- Confirmation: NOT PUBLISHED
- Status check: EOB; Member Services if no EOB has arrived after 30 days
- Processing time: NOT PUBLISHED: contractual turnaround varies; public FAQ gives a 30-day follow-up threshold
- Member deadline: NOT PUBLISHED
- Deadline basis: YES: employer benefit plan and card control
- Mental health route: Dedicated Carelon behavioral-health route for nonparticipating provider claims
Confirm the address, fax number or portal path on the insurer's own claims page before you send; read on 10-09-2026.
Read on 10-09-2026 from https://ets.valueoptions.com/OnlineClaimSubmission/members/forms/files/Claims_Form.pdf;https://www.carelonbehavioralhealth.com/providers/contact-us. Confirm the address, fax number or portal path on the insurer's own claims page before you send.