Oncology Services: Resources

Shared resources

Procedure codes for which providers must request prior authorization — See this document to determine which procedure codes require prior authorization
Oncology: For cancer support, oncology drugs and radiation oncology — Includes information about care management and utilization management programs

Resources for services managed by EviCore

Services reviewed by EviCore for Blue Cross and BCN — Outlines the types of services for which EviCore by Evernorth^® manages prior authorizations, how to submit requests, where to find clinical criteria and guidelines, and more
EviCore Authorization: Quick Reference — Explains how to submit prior authorization requests to EviCore

Blue Cross resources

Resources for services managed by Carelon

For URMBT non-Medicare members: Radiation oncology prior authorization list for UAW Retiree Medical Benefits Trust non-Medicare members — A list of radiation oncology procedures that require prior authorization through Carelon Medical Benefits Management for URMBT non-Medicare members. Includes modalities, grouper ID required codes and grouper names
Frequently asked questions about Carelon: For cardiology, radiology (high technology) and sleep studies (in lab)— Answers to questions about prior authorization requirements for cardiology services, high-tech radiology services and in-lab sleep studies

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.