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Which Kaiser Colorado regions are managed by Carelon vs. Kaiser?

As of January 1, 2026, the relationship between Kaiser Permanente and Carelon Behavioral Health has changed. Geographic region is no longer the only factor in determining how a client's behavioral health benefits are managed.

  • Carelon is no longer managing PPO plans for any Kaiser members, regardless of their location.

  • Eligibility now depends on a combination of the client's specific plan type (HMO vs. PPO) and their home region.

  • Clients with HMO plans living in Northern Colorado (Loveland and North) or Southern Colorado (Larkspur and South) will continue to be managed by Carelon. 
  • Clients living within the Denver/Boulder Metro regions are managed by Kaiser. This is *generally* anything South of Loveland and North of Larkspur.

How to Verify Coverage

Because the rules for "carve-outs" (where a different company like Carelon manages the mental health portion of the insurance) have become more technical, you should not guess based on the client's zip code alone.

  1. Complete a Benefit Verification Form for every potential Kaiser Colorado client.

  2. Our benefits team will manually check the client's specific region and plan type (HMO or PPO).

  3. The team will notify you directly if the client’s benefit is "carved out" to Carelon, which would make them out-of-network for your CCS-Kaiser contract.

Why Verification is Critical

Relying on old regional maps can lead to unpaid claims. Using the CCS verification process ensures that both you and the client have a clear understanding of costs before the first session begins.