eviCore simplifies authorization process for radiation oncology, starting July 1, 2020

On July 1, 2020, eviCore healthcare^® will simplify the authorization process for radiation oncology by asking Clinical Decision Support questions, rather than their traditional clinical questions. This applies to authorizations for breast, prostate and non-small-cell lung cancer.

As a result, you'll need to answer far fewer clinical questions when submitting these authorization requests.

What you need to do

The steps to submit authorization requests to eviCore won't change. You'll follow the typical process of logging in to the eviCore portal at www.evicore.com*, initiating a request for Clinical Certification for Radiation Therapy and entering information about the member.

For breast, prostate and non-small-cell lung cancer, the system will prompt you to answer the CDS clinical questions. After answering the questions, you'll be presented with a list of treatment regimens that you can select from. There's also an option to enter a custom treatment regimen.

Additional information

eviCore manages authorizations for radiation oncology for most Blue Cross' PPO fully insured groups and for Medicare Plus Blue^SM PPO, BCN HMO^SM and BCN Advantage^SM members.

For more information, see the Blue Cross eviCore-Managed Procedures or the BCN eviCore-Managed Procedures pages of this website.

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Posted: June 2020
Lines of business: Blue Cross Blue Shield of Michigan and Blue Care Network