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Update to our Radiation Treatment of Breast Carcinoma guideline

June 1, 2017

Independence delegates precertification of non-emergent outpatient radiation therapy services for all commercial HMO, POS, EPO, and PPO members and Medicare Advantage HMO, POS, and PPO members to CareCore National, LLC d/b/a eviCore healthcare (eviCore), an independent company. eviCore maintains Radiation Therapy Clinical Guidelines for Independence that contain medical necessity criteria used during the precertification process for our members.

Effective September 1, 2017, Independence will update its Radiation Treatment of Breast Carcinoma guideline to indicate that a hypofractionated regimen is the preferred treatment for patients with early stage (T1-2N0) breast carcinoma who meet certain criteria. For these patients, a request for precertification of conventional fractionation will require a peer-to-peer call with an eviCore Radiation Oncologist.

The Independence Radiation Therapy Clinical Guidelines ? Effective 9/1/2017 is available for review on eviCore?s website. These guidelines include the updated criteria for treatment of breast carcinoma using hypofractionated radiation therapy.

Requesting precertification

You can initiate precertification for non-emergent outpatient radiation therapy services, including radiation treatment of breast carcinoma, in one of the following ways:

  • NaviNet® web portal. Select CareCore from the Authorizations option in the Independence Workflows menu.
  • Telephone. Call eviCore directly at 1-866-686-2649.

If you have questions about the new guidelines, you may contact eviCore?s Customer Service support at 1-800-918-8924 from 7 a.m. to 7 p.m.

NaviNet is a registered trademark of NaviNet, Inc., an independent company.


This content was prepared for the Provider News Center and may not be reproduced in any way without the express written permission of Independence Blue Cross. Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association.
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