How to Bill Kaiser Through Carelon: Referrals, Authorization Numbers, and Getting Paid

The three players, in one table

Southern California works differently, and I could not confirm a current Kaiser Southern California arrangement with Carelon in an official source. Everything below is about Kaiser Northern California members referred to Carelon.

How a Kaiser member ends up referred out to Carelon

Kaiser says members can start mental health care without a referral by talking to their primary care doctor or calling the mental health department, that Kaiser begins with an assessment, and that depending on where the member lives and the care they need, Kaiser may recommend a provider outside Kaiser Permanente. Kaiser’s 2024 Northern California HMO Provider Manual describes the same sequence for its direct network: local Kaiser mental health clinics evaluate members first and then refer to contracted providers (KP NCAL HMO Provider Manual 2024).

In my experience, the Carelon version looks like this:

1. The member calls Kaiser mental health (or asks their Kaiser doctor) and completes Kaiser’s intake or triage.
2. Kaiser decides an outside referral is appropriate, often because of access, location, language, or specialty.
3. Kaiser sends the referral to Carelon. The member is told they can see a therapist in the Carelon network.
4. The member finds a Carelon therapist through Carelon’s provider search or a list they are given, or they already have someone in mind who is in the Carelon network.
5. The therapist calls or logs in to Carelon and gets the authorization.

The step people skip is number 1. A Kaiser member who simply finds you online and calls you has not been referred out yet. Carelon has nothing to authorize.

How the client gets the Carelon referral (what the client does first)

Here is what I tell Kaiser members who want to see me, in this order. The client does this part, not the therapist, because only the member can go through Kaiser’s intake:

1. Call Kaiser mental health for your area (the number is on kp.org and on your Kaiser materials), or message your Kaiser primary care doctor.
2. Complete Kaiser’s intake or assessment.
3. Ask directly whether Kaiser can refer you to an outside therapist through Carelon, and explain why (wait times, location, a specialty, a language, a therapist you already know who is in the Carelon network).
4. If Kaiser approves, ask that the referral go to Carelon, and ask what you should expect next.
5. Once the referral is done, tell your therapist. Your therapist takes it from there.

Why the referral makes the authorization call easy

In my experience, this is the part nobody explains. Before the referral exists, the therapist’s call to Carelon goes nowhere: Carelon has no Kaiser referral on file for that member, so there is nothing to authorize, and you end up telling the client to go back to Kaiser. After the referral exists, the call is short. Carelon finds the member, sees the Kaiser referral, confirms you are a contracted provider, and issues an authorization to you.

That is why I always have the client do their part first. It saves everyone two or three phone calls, and it keeps the client from feeling bounced around.

The authorization number, and why it goes on every claim

Carelon’s provider handbook says authorizations or certifications are for a specific number of services or units and a specific time period, and that claims must match the authorization that applies to the services to avoid delays. It also lists “no authorization on file for a service that requires prior authorization” as an example of a claim edit (Carelon Provider Handbook, sections 9.04 and 10).

In practice, every authorization you get should give you:

• The authorization number. Write it in your client’s billing record the day you get it.
• Who it is for: the member, and the rendering provider (you, your NPI, and the right tax ID).
• What it covers: the service or procedure codes, and how many visits or units.
• When: a start date and an end date.

On a paper or electronic CMS-1500, the authorization number goes in Item 23, Prior Authorization Number, which the national claim form instructions define as the field for a prior authorization or referral number assigned by the payer (NUCC 1500 instruction manual, v13). Your billing software usually has a field for it in the client’s insurance or authorization screen; fill it there so it prints on every claim.

Visits, units, and expiration dates

Track three things for every Kaiser/Carelon client: visits used, visits left, and the end date. An authorization can run out in two ways, and both cause denials:

• You use all the authorized visits before the end date.
• The end date passes, even if visits are left over.

I keep a simple tracker per client: authorization number, codes covered, visits authorized, start date, end date, and a reminder set a few sessions before either limit. ProviderConnect lets you view authorization letters and claim status, so check there rather than relying on memory.

Requesting more sessions (concurrent review)

When you need more care than was authorized, you ask before the current authorization runs out. Carelon calls continued authorization requests concurrent review, and both ProviderConnect and the handbook list concurrent review requests as something you can submit through the portal. Carelon’s handbook says it may ask for clinical information at various points to confirm ongoing need, and that it can return requests that are incomplete or lack specificity.

1. Look at the authorization a few sessions before the visits or dates run out.
2. Submit the request in ProviderConnect (Carelon’s preferred method for Kaiser Northern California authorizations) or call the Carelon authorization line Carelon lists for Kaiser Northern California: 855-471-7005, Monday to Friday, 8 a.m. to 8 p.m. Eastern (Carelon: California resources, Kaiser Permanente of Northern California).
3. Have your current treatment information ready, documented in your record: diagnosis, goals, progress, and why continued care is needed.
4. Record the new authorization number, codes, visit count, and dates. A new authorization may have a new number; use the right one for each date of service.

Submitting the claim

The payer ID. Carelon’s portal page says “BHOVO is the standard payer ID for Carelon Behavioral Health” and to check your state-specific materials to confirm whether another ID applies (Carelon: provider portals). Carelon’s California orientation also lists Payer ID BHOVO for electronic claims. Carelon’s Kaiser Northern California section does not list a different payer ID as of October 19, 2026. Before your first claim, confirm the payer ID in your welcome letter or with Carelon, and never use a Kaiser payer ID for a Carelon-referred member.

Timely filing. Carelon’s national handbook says that unless your provider agreement says otherwise, claims must be submitted within 90 calendar days from the date of service. Your agreement controls, so look it up and calendar it.

Line items. The handbook says each billing line should be one date of service and one procedure code, and for timed psychotherapy codes the actual time must be documented, with start and stop times. Carelon’s Kaiser Northern California reminders say to pick the code that matches the time you spent; for example, 90837 needs at least 53 documented minutes, otherwise 90834 is the right code.

Payment. Carelon is moving electronic payments to the Zelis ePayment Center and asks providers not yet enrolled to register at carelon.epayment.center (Carelon: Zelis transition).

Common denials and how to fix them

Disputes. Carelon’s California orientation says written disputes use Carelon’s Claims Dispute Resolution form and must be filed within 365 days from the date of denial, by email to ProviderDisputeResolution@carelon.com or by mail; there is also a California Provider Dispute Resolution form on Carelon’s California page (CA PDR form). Carelon’s national handbook says billings are considered final unless an adjustment or review is requested within the time in your agreement, or within 60 calendar days of the EOB if your agreement is silent. Check your agreement.

What the client does vs. what the therapist does

A worked example (fictional)

Everything here is made up, including the numbers. Real authorizations vary by member and clinical need.

1. “Jordan” (fictional) has a Kaiser Northern California HMO plan and calls my office asking for therapy.
2. My intake coordinator asks whether Jordan has been referred out through Carelon. Jordan has not. We explain the Kaiser step and send our one-page “how to get a Carelon referral” handout. Nothing is scheduled yet.
3. Jordan completes Kaiser’s intake. Kaiser approves an outside referral through Carelon. Jordan calls us back to say it is done.
4. I log in to ProviderConnect through Availity and request the authorization. Carelon issues authorization number TEST-0000-EXAMPLE for 8 visits of 90834 from March 3 to June 30 (fictional).
5. We enter the authorization number in Jordan’s billing profile so it prints in Item 23 of every claim, and set a reminder at visit 6 and two weeks before June 30.
6. At visit 6, I submit a concurrent review request with current treatment information. Carelon authorizes more visits under a new authorization with new dates. We update the tracker.
7. Claims go to Carelon through Availity under the Carelon payer ID in our welcome materials, one date of service per line, with start and stop times in each note. Nothing is ever sent to Kaiser.

Call scripts

Script 1: the client calls Kaiser

Script 2: the therapist calls Carelon for the authorization

Write down the date, time, the representative’s name, and a call reference number. Share member details only over the phone or secure portal, never by regular email.

Script 3: the therapist requests more sessions

Documentation that protects your claims

• Start and stop times for every timed psychotherapy session (Carelon’s handbook requires the actual time to be documented).
• A treatment plan and progress notes that support medical necessity for what was authorized.
• California’s timely access rule for follow-up appointments (SB 221): Carelon’s Kaiser Northern California reminders say follow-up therapy appointments should be offered within 10 business days unless the treating therapist documents that a longer wait will not be detrimental, in a non-detriment statement in the record.
• Copies of every authorization letter, saved where your biller can find them.

Bill for what you legitimately provide and document, and follow the payer’s authorization and documentation rules.

Associates, groups, and telehealth

• Associates. Associate billing must be confirmed in writing with each payer, including Carelon. Carelon’s handbook says participating providers should not bill in their own name for services provided by an intern or another clinician, and it also lists a Supervised Clinician Group Roster form. Don’t put an associate on a Kaiser authorization, or bill their session under your NPI, until Carelon confirms in writing how it wants that done for your contract. Billing a session as if you provided it yourself can be a false claim. See Can associates bill insurance in California?.
• Groups. The authorization must match the provider on the claim. If your group contract bills under a Type 2 NPI, ask Carelon how it wants the rendering provider listed.
• Telehealth. Carelon’s handbook has a telehealth section (10.13). Use the place of service and modifiers your agreement requires, and document the modality.