Oncology Services

Resources

Prior authorizations for oncology services are managed as follows.

Service	Members
Medical oncology	Visit the Medical Benefit Drugs page on this website.
Proton beam therapy	EviCore by Evernorth^® manages prior authorizations for: Blue Cross commercial fully insured groups and individual members Medicare Plus Blue^℠ members Blue Care Network commercial members BCN Advantage^℠ members Carelon Medical Benefits Management manages authorizations for Blue Cross commercial self-funded groups: Includes UAW Retiree Medical Benefits Trust non-Medicare members Excludes Blue Cross and Blue Shield Federal Employee Program^® members
Radiation oncology, other than proton beam therapy	EviCore manages prior authorizations for: Blue Cross commercial fully insured groups and individual members Medicare Plus Blue members BCN commercial members BCN Advantage members Carelon manages prior authorizations for Blue Cross commercial self-funded groups — For UAW Retiree Medical Benefits Trust non-Medicare members only

Service

Members

Medical oncology

Visit the Medical Benefit Drugs page on this website.

Proton beam therapy

EviCore by Evernorth^® manages prior authorizations for:

Blue Cross commercial fully insured groups and individual members
Medicare Plus Blue^℠ members
Blue Care Network commercial members
BCN Advantage^℠ members

Carelon Medical Benefits Management manages authorizations for Blue Cross commercial self-funded groups:

Includes UAW Retiree Medical Benefits Trust non-Medicare members
Excludes Blue Cross and Blue Shield Federal Employee Program^® members

Radiation oncology, other than proton beam therapy

EviCore manages prior authorizations for:

Blue Cross commercial fully insured groups and individual members
Medicare Plus Blue members
BCN commercial members
BCN Advantage members

Carelon manages prior authorizations for Blue Cross commercial self-funded groups — For UAW Retiree Medical Benefits Trust non-Medicare members only

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.

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.