Radiation therapy prior authorization for Oxford Health Plan

Effective Nov. 7, 2021, Optum will manage Oxford Health Plan prior authorization requests for outpatient radiation therapy.

What’s changing

For Oxford Health Plan members, we’ll require prior authorization for the following radiation therapy services, formerly managed by eviCore:

  • Intensity-modulated radiation therapy
  • Proton beam therapy
  • Stereotactic body radiation therapy/stereotactic radiosurgery
  • Fractionation for breast cancer, prostate cancer, lung cancer and bone metastasis
  • Image-guided radiation therapy
  • Special and associated radiation therapy services
  • Selective internal radiation therapy (SIRT), Yttrium 90 (Y90) and implantable beta-emitting microspheres for treatment of malignant tumors

Optum will begin accepting prior authorizations submissions Nov. 1, 2021, for prior authorizations effective Nov. 7, 2021, and later.

This change will affect commercial health plan members in the Oxford Health Plan, effective Nov. 7, 2021. Any active radiation therapy prior authorizations requested up until Nov. 6, 2021, will remain in place through the former process.

A new prior authorization request will be required for radiation therapy services that start on Nov. 7, 2021 or after for specific CPT® codes.

Important notes

  • Prior authorization for radiation therapy will be part of the comprehensive management of oncology service requests in the Cancer Guidance Program
  • If you already received a prior authorization for radiation therapy services in scope for prior authorization administered prior to Nov. 7, 2021, you DO NOT need to submit a new prior authorization request for that approved treatment
  • The coverage determination guidelines we use for the radiation therapy services will be available at UHCprovider.com/policies > Medical & Drug Policies and Coverage Determination Guidelines for Commercial

Submit a prior authorization request

To submit an online request, beginning Nov. 1, 2021, for prior authorization, starting Nov. 7, 2021:

  1. Go to the Provider Portal at UHCprovider.com > Sign in
  2. Select Prior Authorization and then Radiology, Cardiology, Oncology and Radiation Oncology 
  3. Select service type, Radiation Oncology
  4. After selecting Oxford as the product type, you will be directed to another website to process the authorization requests 

For more information, go to UHCprovider.com

Questions?

Please email unitedoncology@uhc.com.

PCA-1-21-01935-VC-News_07302021