Welcome!

Beginning in May 2026, Evolent will manage medical and radiation oncology prior authorizations on behalf of Highmark.

• ​Practices will continue to submit new authorizations through Availity Essentials®.

• Requirements apply to Commercial fully insured, Affordable Care Act (ACA), and Medicare Advantage (MA) members in Delaware, Pennsylvania, and West Virginia; Pennsylvania CHIP; and New York Medicare Advantage.

• Prior authorization is required for chemotherapy, hormonal therapy, supportive agents, symptom management medications, and radiation oncology services for diagnoses in these ranges: C00–D09.0, D37.01–D49.9, D61.810, D61.82, D63.0, D64.0–D64.81, D70.1, D72.822, D75.81, E34.00, E34.01 and E34.09.

• The scope for review will be based on diagnosis and HCPCS/CPT codes and not on the requesting provider's specialty. Evolent will review requests from all provider specialties that meet the diagnosis and HCPCS/CPT code requirements.  

• Practices will have fast, consistent determinations with dedicated oncology reviewers and evidence-based pathways.

Evolent’s oncology clinical pathways do not need to replace third-party pathway tools providers are already using. Practices may choose to continue using their established pathways in parallel with submitting oncology authorization requests, even when Evolent is managing the review. However, by following Evolent’s pathways, practices may benefit from improved regimen-based quality and efficacy as well as faster authorization approvals.

Providers may begin contacting Evolent on May 1, 2026, to secure prior authorization for services. This does not affect authorizations submitted prior to May 1. Highmark will make decisions for authorizations received prior to May 1; Evolent will make decisions for authorizations received after May 1. For prior authorization requests:

• Practices will continue to submit new/initial authorization requests through Availity Essentials. Click here for more information regarding registration for the Availity portal, Availity Essentials Guidance.

• For requests that go to review, providers must upload supporting clinical documentation directly in the Evolent CarePro portal.

  • Users new to CarePro: Evolent will automatically create new CarePro user login credentials post authorization submission and send to users via email.

  • Existing users may continue using their current CarePro login credentials.

• Submit via telephone at 1.888.999.7713 (medical oncology – option 2; radiation oncology - option 3).