Oncology Services

Resources

Prior authorizations for oncology services are managed as follows.

Service	Members
Medical oncology, including therapeutic radiopharmaceuticals	Visit the Medical Benefit Drugs page on this website.
Radiation oncology, including proton beam therapy^{1, 2}	OncoHealth manages prior authorizations for dates of service on or after Sept. 1, 2026, through the Oncology Value Management program for: Blue Cross Blue Shield of Michigan and Blue Care Network commercial — Most fully insured groups and individual members Exception: MESSA members don't have requirements under the Oncology Value Management program Most self-funded groups — To determine which self-funded groups have requirements under the program, see the Oncology Value Management program opt-out list for self-funded groups. Medicare Plus Blue^℠ and BCN Advantage^℠ members Carelon Medical Benefits Management manages prior authorizations for Blue Cross commercial self-funded groups — For UAW Retiree Medical Benefits Trust non-Medicare members only Exception: This doesn't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

Service

Members

Medical oncology, including therapeutic radiopharmaceuticals

Visit the Medical Benefit Drugs page on this website.

Radiation oncology, including proton beam therapy^{1, 2}

OncoHealth manages prior authorizations for dates of service on or after Sept. 1, 2026, through the Oncology Value Management program for:

Blue Cross Blue Shield of Michigan and Blue Care Network commercial —

Most fully insured groups and individual members
Exception: MESSA members don't have requirements under the Oncology Value Management program
Most self-funded groups — To determine which self-funded groups have requirements under the program, see the Oncology Value Management program opt-out list for self-funded groups.

Medicare Plus Blue^℠ and BCN Advantage^℠ members

Carelon Medical Benefits Management manages prior authorizations for Blue Cross commercial self-funded groups — For UAW Retiree Medical Benefits Trust non-Medicare members only
Exception: This doesn't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

For Blue Cross commercial groups, see the Carelon exclusion list for Blue Cross Blue Shield of Michigan commercial to learn about the health plans, groups, and settings or scenarios for which prior authorization isn't required.
The requirements outlined above don't apply to the UAW Retiree Health Care Trust (group number 70605) or the UAW International Union (group number 71714).

How to submit prior authorization requests

To learn how to submit requests, see our Getting Started page.

Submit requests before providing services.

Utilization Management Criteria

Visit our Utilization Management Criteria page.

¹For dates of service before Sept. 1, 2026: (a) EviCore by Evernorth managed prior authorizations for proton beam therapy for Blue Cross commercial fully insured groups and individual members, Medicare Plus Blue^℠ members, BCN commercial members and BCN Advantage^℠ members and (b) Carelon managed prior authorizations for proton beam therapy for most Blue Cross commercial self-funded groups.

²For dates of service before Sept. 1, 2026, EviCore managed prior authorizations for radiation oncology procedures other than proton beam therapy for Blue Cross commercial fully insured groups and individual members, Medicare Plus Blue members, BCN commercial members and BCN Advantage members.

Carelon Medical Benefits Management is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.

EviCore by Evernorth is an independent company that contracts with Blue Cross Blue Shield of Michigan and Blue Care Network to manage prior authorizations for select services.

OncoHealth is an independent company supporting Blue Cross Blue Shield of Michigan and Blue Care Network by providing cancer support services.