As previously communicated, providers are required to obtain
precertification through CareCore National, LLC d/b/a eviCore healthcare
(eviCore), an independent company, for non-emergent outpatient radiation
therapy services for all commercial and Medicare Advantage HMO, POS, and PPO
members.
Effective January 1, 2016, the list of radiation therapy procedure
codes that require precertification has been updated. The following medical
policies include an updated list of procedure codes that require
precertification as well as a link to the criteria that eviCore will use to
determine medical necessity for radiation therapy services:
- Commercial: #09.00.56b: Radiation Therapy Services;
- Medicare Advantage: #MA09.020b: Radiation Therapy Services.
To view these policies, visit our Medical Policy Portal. Select
Accept and Go to Medical Policy Online, and then select the
Commercial or Medicare Advantage tab from the top of the page,
depending on the version of the policy you?d like to view. Type the policy name
or number in the Search field.
Requesting precertification
You can initiate precertification for non-emergent outpatient radiation
therapy in one of the following ways:
- NaviNet® web portal. Select eviCore/CareCore
from the Authorizations option in the Independence Workflows menu.
- Telephone. Call eviCore directly at 1-866-686-2649.
NaviNet is a registered trademark of NaviNet, Inc., an
independent company.