The Ambetter Health plans below have partnered with Evolent, a leading oncology quality management company, to implement a new radiation oncology prior authorization program designed to streamline administrative processes and support the delivery of high-quality, evidence-based cancer care.
IL: Ambetter of Illinois KS: Ambetter from Sunflower Health Plan OH: Ambetter from Buckeye Health Plan MO: Ambetter from Home State Health WA: Ambetter from Coordinated Care |
Effective June 1, 2026, radiation oncology services administered in a physician office, outpatient hospital or ambulatory setting will be submitted to Evolent for prior authorization for members with a primary diagnosis within the following diagnosis code range:
Cancer Diagnoses = C00 - D09, D37 - D44, E34.0 Hematology Diagnosis = 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 N&V = R11 Radiation Oncology services requiring authorization include Brachytherapy, Conformal, Conventional, IMRT, IGRT, Proton and Neutron Beam Therapy and Stereotactic Radiosurgery.
Providers may begin contacting Evolent on June 1, 2026 to secure prior authorization for radiation oncology services scheduled on or after June 1, 2026. Prior authorization requests can be submitted to Evolent:
Via the Evolent CarePro portal at evolent.com/provider-portal, select CarePro Via telephone: 1.888.999.7713, option 3 for Radiation Oncology
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