Health Care Benefit Managers
Wellpoint Washington 2026 Marketplace
A health care benefit manager (HCBM) is any person or entity that provides services to or acts on behalf of a health carrier or employee benefits program.
HCBMs directly or indirectly impact the determination or use of benefits for or patient access to health care services, drugs and supplies. They include, but are not limited to, specialized benefit types, such as pharmacy, radiology, laboratory and mental health.
Effective Jan. 1, 2022, health care benefit managers (HCBMs) will be required to register with the Washington state Office of the Insurance Commissioner (OIC). Here we list the HCBMs that Wellpoint currently contracts with, carriers and the services they provide.
For more information on HCBMs, visit the OIC website.
Overview of HCBMs and Services
|
Entity Name |
Service Provided |
|---|---|
|
Advanced Medical Reviews, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Carelon Behavioral Health, Inc. |
Utilization reviews, outcome management, dispute resolution, grievances or appeals determinations |
|
Carelon Global Solutions India LLP |
Claims processing and repricing, benefit determinations, payment or payment authorization to providers and facilities |
|
Carelon Global Solutions Philippines, Inc. |
Prior authorization or preauthorization of benefits or care, utilization reviews |
|
Carelon Health, Inc. |
Outcome management, case management |
|
Carelon Insights, Inc. |
Payment integrity and subrogation services |
|
Carelon Medical Benefits Management, Inc. |
Outcome management, utilization reviews |
|
CarelonRx, Inc. |
Pharmacy Benefits Manager |
|
Cotiviti, Inc. |
Payment or payment authorization to providers and facilities |
|
EyeMed Vision Care, LLC |
Vision provider network management |
|
MCMC Services, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Lone Star Consulting Services, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Network Medical Review Company, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Prest & Associates, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Zelis Healthcare, LLC |
Payment or payment authorization to providers and facilities |
Service Provided |
|
|---|---|
Entity Name |
|
|
Advanced Medical Reviews, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Carelon Behavioral Health, Inc. |
Utilization reviews, outcome management, dispute resolution, grievances or appeals determinations |
|
Carelon Global Solutions India LLP |
Claims processing and repricing, benefit determinations, payment or payment authorization to providers and facilities |
|
Carelon Global Solutions Philippines, Inc. |
Prior authorization or preauthorization of benefits or care, utilization reviews |
|
Carelon Health, Inc. |
Outcome management, case management |
|
Carelon Insights, Inc. |
Payment integrity and subrogation services |
|
Carelon Medical Benefits Management, Inc. |
Outcome management, utilization reviews |
|
CarelonRx, Inc. |
Pharmacy Benefits Manager |
|
Cotiviti, Inc. |
Payment or payment authorization to providers and facilities |
|
EyeMed Vision Care, LLC |
Vision provider network management |
|
MCMC Services, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Lone Star Consulting Services, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Network Medical Review Company, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Prest & Associates, LLC |
Dispute resolution, grievances or appeals to benefits determinations |
|
Zelis Healthcare, LLC |
Payment or payment authorization to providers and facilities |