Sleep Solution
Help your members sleep better
Carelon provides sleep benefits utilization management that helps improve sleep care while managing unnecessary costs. We work with your providers to support evidence-based, clinically appropriate testing and treatment for sleep apnea and other common sleep disorders. We also help manage treatment adherence and reduce spending on unused supplies. This comprehensive approach can support long-term savings across your sleep benefits program.
Lines of business
- Commercial
- Medicare
- Medicaid
- Federal employee
What happens when you optimize sleep benefits management?
Sleep care can involve unnecessary variation in testing, treatment, and costs without effective management. We help optimize the care experience from diagnosis through treatment and monitoring. By supporting evidence-based decisions at each step, we help your members receive appropriate care while helping you manage costs.
Improve your members’ whole health
Sleep plays an important role in physical and behavioral health. By making it easier for members with sleep disorders to get the testing and treatment that fit their clinical needs, we help support better sleep that benefits the whole person.
Guide care to convenient, affordable settings
Sleep studies performed in outpatient departments can cost thousands of dollars while potentially being less comfortable and convenient for your members. We help solve for both. When clinically appropriate, we help guide members to lower-cost home-based sleep studies that can offer a more convenient experience.
Help reduce your health plan’s total cost of care
Demand for pain management and rehabilitation keeps rising. We help reduce unnecessary spending on it. We support informed treatment decisions that can help reduce extended or ineffective courses of therapy and inappropriate surgeries, while promoting more appropriate use of health plan resources.
Inside our Sleep Solution
Sleep management involves complex clinical decisions. But by bringing together clinical guidance, technology, and related support, your providers can more quickly make informed decisions when it counts.
Clinical appropriateness review
Clinical setting optimization (optional)
Treatment compliance monitoring (optional)
Device recommendations
Practice engagement resources
Advanced analytics and reporting
How our solution works
Request
Your providers submit requests to us online or by phone.
Review
Our automated platform reviews requests in real time against applicable clinical criteria.
Determine
Requests that meet clinical criteria can be approved immediately. When additional review is needed, our clinical reviewers, including board-certified sleep specialists, are available to consult with your providers about requests that don’t meet our clinical criteria or the health plan’s medical policy.
Redirect
When clinically appropriate, we can redirect in-lab testing to home-based testing.
Synchronize
We share request data with your system(s) for claims, care management, or reporting purposes, as applicable.
Ready for the next step?
Connect with us to explore the potential impact of our Sleep Solution for your health plan.
Explore related solutions
Related articles
Stay informed with insights on industry trends, clinical perspectives, and Carelon’s evidence-based approaches to helping health plans guide members to appropriate, cost-effective care.
Frequently asked questions about sleep solutions
Are you a health plan member?
If you’re a health plan member and have a question about your health plan, please call the Member Services number on the back of your member ID card.
Provider inquiries: For questions about a request or the Provider Portal: Call 800-252-2021 or contact our support team .
Business hours: 8 a.m. to 5 p.m. CT.