Treatment plan authorization process

Each payer must tell you whether to use Eviti Connect for Oncology for chemotherapy treatment plans, radiation therapy treatment plans, or both. Submit only treatment plans that the payer accepts. If you don't know which type of treatment plans a payer accepts, please call the payer.

The following steps describe the treatment plan authorization process using Eviti Connect for Oncology:

  1. In Eviti Connect for Oncology, you enter the treatment plan that the physician prescribed for the patient.
  2. We compare your treatment plan to the evidence-based regimens in the Eviti library. We may prompt you for more information to help us find the appropriate regimen.
  3. You choose the regimen that most closely matches the prescribed treatment plan. You may be asked to review the treatment details and edit them so they match your prescribed treatment plan. Follow the onscreen instructions that appear for each treatment plan.
  4. As you enter the treatment plan details, if it deviates from evidence-based guidelines, you see the Medical Review Required screen. From this screen, you can review the deviations and fix any data entry errors. If the treatment plan deviates because the physician prescribed a different treatment, you must provide the required documentation listed on this screen for our medical team to review.
  5. You submit the treatment plan.
    • If the treatment plan meets all the guidelines, we assign it an automatic Eviti code. We display the payer's Eviti code definition, and any instructions that the payer chose to provide. We also send you an email with this information.
    • If the treatment plan deviates from the guidelines, our medical team must review it. We may need to talk to the treating physician to gather more information. After we complete the review, we send you an email that indicates whether we issued an Eviti code to the treatment plan.
  6. The payer reviews the treatment plan, and sends you an authorization or denial letter.