As previously communicated, providers are required to obtain
precertification through CareCore National, LLC d/b/a eviCore healthcare
(eviCore) for non-emergent outpatient radiation therapy services for all
commercial HMO and POS members.
Effective January 1, 2016, the list of radiation therapy procedure
codes that require precertification has been updated. Medical Policy
#09.00.56b: Radiation Therapy Services includes 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.
To view this policy, visit our Medical Policy Portal.
Select Accept and Go to Medical Policy Online, and then select the
Commercial tab from the top of the page. 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 AmeriHealth Workflows menu.
- Telephone. Call eviCore directly at 1-866-686-2649 .
NaviNet is a registered trademark of NaviNet, Inc.