Treatment plan statuses
Treatment plans may appear in any of the following statuses.
- In Progress
- The treatment plan was started but not yet submitted. Click Not Submitted to edit and submit the treatment plan.
- EV-{unique code}
- We issued an Eviti code for the treatment plan, which means it follows
evidence-based guidelines and health plan language, and represents appropriate
care for the patient.
If you need the authorization right away, please call the payer. Find their number on the patient's member ID card.
- Eviti Code Not Issued
- We did not issue an Eviti code for the treatment plan, which means one of the
following:
- The treatment plan does not meet evidence-based guidelines or health plan language.
- You didn't supply sufficient medical records for a treatment plan that didn't receive an automatic Eviti code.
- We requested a peer-to-peer clinical discussion with the prescribing physician, but it did not occur.
To request more information about a rejected treatment plan, call the payer, or call NantHealth Support at 1-888-482-8057.
- Partial Approval: EV-{unique code}
- We issued an Eviti code for some of the drugs in the treatment plan.
- Pending Eviti Review
- You submitted a treatment plan that our medical office must review, but we have
not yet finished the review. Click Attach
Files to
attach
additional documentation.
If you need an expedited medical review, call NantHealth Support at 1-888-482-8057.
- Pending Payer Review
- You submitted a treatment plan that deviates from evidence-based care or health
plan language, but we think it's appropriate care. The payer has not yet
completed their review.
All clinical trials require payer review.
If you need the authorization right away, please call the payer. Find their number on the patient's member ID card.
- Pending Reconsideration
- You asked that we reconsider a rejected treatment plan. We reopened the treatment plan to start the review and peer-to-peer process, but it's not yet complete.
- Reconsideration - Upheld: Eviti Code Not Issued
- We reviewed the rejected treatment plan again, but did not issue an Eviti code for the treatment plan. The treatment plan does not meet evidence-based guidelines or health plan language.
- Reconsideration - Overturned: Eviti Code Issued
-
We reviewed the rejected treatment plan again, and after a peer-to-peer clinical discussion, we issued an Eviti code for the treatment plan. The treatment plan follows evidence-based guidelines and health plan language, and represents appropriate care for the patient.
- Pending Appeal
- You appealed the payer's decision about a treatment plan. The payer has not yet completed their review.
- Appeal - Upheld: Eviti Code Not Issued
- We reviewed the rejected treatment plan again, but did not issue an Eviti code for the treatment plan. The payer denied the appeal.
- Appeal - Overturned: Eviti Code Issued
-
We reviewed the rejected treatment plan again, and after a peer-to-peer clinical discussion, we issued an Eviti code for the treatment plan. The treatment plan follows evidence-based guidelines and health plan language, and represents appropriate care for the patient.