| Radiation Oncology Scope of Service | |
| In Scope Diagnoses | Cancer Diagnoses: C00 – D00, D37 – D44, E34.0 |
| Hematology Diagnoses: D45-D49, D59.10-D59.19, D61.81, D61.82, D63.0, D63.8, D64.2-D64.3, D64.81, D64.89, D64.9, D68.59, D69.3, D69.41, D69.59, D69.6, D69.8, D69.9, D70.1-D70.9, D72.8, D72.9, D73.81, D73.9, D75.1, D75.81, D75.82 | |
| Places of treatment | 11 – Provider office 19 – Outpatient off-campus 22 – Outpatient on-campus 24 – Ambulatory |
How do I obtain prior authorization?
- By submitting requests to Evolent: * On-line at my.newcenturyhealth.com
- Via telephone at 1.888.999.7713 (Radiation Oncology–option 3)
Which specialties are included in the Oncology Quality Management Program?
- Radiation oncology will submit their prior authorizations through Evolent
- Please visit https://www.alliancehealthplan.org/providers/procedure-code-lookup-tool/ to check which services will require an authorization for Alliance Health on October 1, 2024
What happens if the authorization request does not meet guidelines?
- If the request does not meet evidence-based treatment guidelines, Evolent may request additional information or initiate a physician discussion with the requesting provider
What will the Evolent authorization number look like, and how long is it valid?
- The Evolent authorization will start with “AR” followed by at least four digits (e.g., AR1000)
- It is valid for the duration indicated on the Service Request Authorization (SRA)
What will happen if the physician does not request and obtain an authorization?
- If authorization is not obtained, Alliance Health may deny payment for the relevant services. Members may not be held responsible or billed for denied charges/services. Providers may only be able to collect the applicable cost share amount directly from the member.
Dedicated Evolent Provider Solutions Manager for on-going operational support. Please contact:
- Name: Claudia Prinstein-Hasbun
- Email: [email protected] | Phone: 571-832-0659
