Radiation Oncology

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Follow the below steps to access the clinical guidelines.

Enter your Health Plan name into the search field and click on the magnifying glass.
Click on the Clinical Guidelines Link.
To access the guideline specific to your request, locate the “reason for denial” section found in your letter.
Identify the guideline title and then search for that guideline title by scrolling down to the table of contents and clicking on the guideline section mentioned in your letter.

Example:

The reason for denial states in your letter states: Based on EviCore Radiation Therapy (RT) Guidelines Section: Radiation Therapy for Bone Metastases, we cannot approve this request.

Enter your Health Plan name into the search field and click on the magnifying glass, open the clinical guidelines document. Scroll to the table of contents and locate the reason for denial mentioned in your letter (example: Bone Metastases).

If you require a copy of the guidelines that were used to make a determination on a specific request of treatment or services, please email the case number and request to: reqcriteria@EviCore.com.

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Resources

Radiation Oncology

Clinical Guidelines

Coding Manual

Requirements for Clinical Appeal

Clinical Guidelines

Coding Manual

Requirements for Clinical Appeal