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Changes effective July 1, 2026 for Medicare Members

Molina Healthcare, including ConnectiCare (a Molina Healthcare company) and Passport by Molina Healthcare, is expanding its collaboration with Evolent as the administrator of the Cardiology and Oncology Quality Management programs. 

What does this mean for providers?

Beginning July 1, 2026, Molina Healthcare Medicare members, (including ConnectiCare and Passport by Molina Healthcare) ages 18 and older will require authorization from Evolent for the following services ordered by all provider specialties:

• Cardiology: Elective diagnostic and interventional cardiovascular services performed in a physician’s office, ambulatory setting, outpatient hospital, or *inpatient hospital setting (*professional services only).

• Oncology: Oncology‑related chemotherapeutic agents, supportive agents, symptom‑management medications, and radiation oncology services administered in a physician’s office, ambulatory center, outpatient hospital and inpatient hospital setting* (*Chimeric Antigen Receptor [CAR] T-cell therapy only) for the following diagnosis codes: C00-D09.9, D37.01-D49.9, D61.810, D61.82, D63.0, D64.0-64.81, D70.1, D72.822, D75.81.

Evolent’s authorization review scope for services above is based on a defined list of applicable CPT and HCPCS codes. Providers should verify PA requirements using Molina Healthcare’s PA Lookup Tool starting July 1, 2026.

Applicable Markets

These prior authorization requirements apply to the following markets: 

New Market = first time program applies in this state; Expanding market = program already active with added service scope or membership.

Submitting Prior Authorizations

Authorizations issued by the health plan before July 1, 2026 for Medicare members are effective until the authorization expiration date. Beginning July 1, 2026, providers should submit all new prior authorization requests to Evolent for services scheduled on or after that date using one of the following methods:

• Log in to the Evolent CarePro provider portal at carepro.evolent.com/

• Calling 1.888.999.7713, available Monday–Friday, 8:00 a.m.– 8:00 p.m. ET

New to CarePro? Register now to create your login and avoid authorization delays beginning July 1, 2026.

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