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CODING & DOCUMENTATION
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Physicians can determine if precertification is required for a patient’s radiation therapy treatment plan by checking eligibility and benefits through ProviderAccess. If precertification is needed, you'll find a link to initiate a precertification request on the Additional Coverage tab in Eligibility and Benefits.
We expanded our partnership with eviCore Healthcare to support the Radiation Therapy program to ensure the radiation therapy services provided to our members are consistent with nationally recognized clinical guidelines. Disease-specific, evidence-based criteria was developed by eviCore to manage the appropriate utilization of radiation therapy services. In addition, eviCore completes medical necessity reviews and authorizations for outpatient radiation therapy services. By working together, we ensure patients receive the most appropriate treatment the first time.
The criteria used by eviCore’s Medical Directors to determine appropriate utilization have been vetted by an expert physician review board of nationally recognized radiation oncologists to ensure that the criteria are in keeping with published research and guidelines from specialty societies, including the:
- American Society for Radiation Oncology
- American College of Radiology
- National Comprehensive Cancer Network
- American Medical Association
A one-time authorization for comprehensive radiation oncology treatment plans will be provided by eviCore. Peer-to-peer conversations for noncovered or partially covered treatment plans will always be conducted with a board-certified radiation oncologist.
An Independent company, eviCore National, LLC provides specialty benefit management of radiology and radiation therapy services.