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.