Reminder: Radiation oncology authorization program with EviCore launches September 15
Our radiation oncology authorizations program with EviCore, first announced in June, will launch on September 15. On that date, authorization requests initiated in prism for impacted codes performed in an outpatient setting will be automatically redirected to EviCore’s provider portal to complete the request.
Be sure to check if you have treatments already scheduled that will now require authorization. Review the impacted code lists to see which services and procedures will be managed by EviCore on our members’ behalf. Bolded codes are those that don’t currently require authorization but will for dates of service on / after September 15.
Below is an FAQ to support your success:
How do you submit an authorization through EviCore?
Our provider portal, prism, will automatically redirect you to EviCore to complete authorization requests when appropriate – no separate login needed. Find step-by-step instructions in our provider training slides.
What if you’ve already submitted a request through GuidingCare?
If you’ve already submitted an authorization request to Priority Health through GuidingCare, there’s no need to resubmit through EviCore. Your existing authorization request will be honored.
What if your patient is undergoing treatment when this authorization program goes live on September 15?
We’ll honor all radiation oncology courses of treatment that are in progress as of EviCore’s management, effective Sept. 15, 2024. Modifications to existing authorizations, such as date extensions, are managed through Priority Health. Contact Priority Health to determine if an authorization for the services underway is already on file.
What if there’s a change in the approved treatment plan (such as adding IGRT or additional treatments)?
An authorization is only valid for the treatment plan requested. A new medical necessity determination is needed for any new or modified treatment plans. If you need to change the plan during the course of treatment, contact EviCore. It’s strongly recommended to call EviCore as soon as it is known there is a change in treatment plan and prior to billing for the corresponding services.
Are provider trainings available?
Yes! EviCore has hosted three provider training webinars, with one remaining on September 17 at 1 p.m. ET. Registration is available online.
Where can you find additional information?
Below you can find links to additional information to help you and your providers be successful through this transition:
- Provider training webinar slides – including an overview of the program, how to submit requests and contact information in case you have questions
- Provider FAQs – answers common questions about EviCore
- Impacted procedure codes – lists the procedures that will be managed by EviCore when performed in an outpatient setting starting September 15
- Clinical guidelines – search for Priority Health to find applicable clinical guidelines. Before September 15, click the Future tab to access the guidelines.