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Health Plans

EviCore onConnect℠

EviCore onConnectSM combines our capabilities in Medical Oncology, Radiation Oncology, Radiology, and Genomic/Molecular Laboratory to create a holistic, patient-centered care model. It integrates pharmacy and medical benefits with regimen-based treatment plans and claims payment integrity to deliver better care at lower costs. Our team of cancer professionals includes over 30 board-certified oncology physicians, 30 nurses, 8 pharmacists, 22 genetic counselors, and more than 150 radiology/cardiovascular physicians who care deeply about the patients we serve.  Using continually updated evidence-based clinical policies, intuitive clinical decision support software, and peer-to-peer consultations, we help providers choose the right tests and treatments for each patient’s unique needs. 

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Our EviCore onConnectSM optimizes the use of evidence-based guidelines to ensure the delivery of high-quality care to patients while avoiding the negative side effects and financial toxicity associated with unproven or less effective healthcare services. 

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EviCore onConnectSM helps providers quickly identify the most appropriate evidence-based test and treatment options using each patient’s unique clinical situation and the most up-to-date clinical guidelines.

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Our EviCore onConnectSM suite allows patients to have confidence that the tests and treatments they receive meet the standards established by the leading experts in their cancer type, drawn from top cancer programs across the country. The solution offers the best chance for a positive outcome, and avoidance of the unnecessary costs and side effects associated with inappropriate health services (e.g., protracted therapy or avoidable emergency room visits and hospitalizations).

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Medical Oncology

Our Medical Oncology solution utilizes the most up-to-date evidence-based clinical guidelines for virtually all cancer types to optimize clinical and financial outcomes by ensuring that clinically appropriate treatment is provided to patients. Our tools utilize adaptable technology that minimizes provider administrative time, captures critical clinical information, and enables meaningful analysis and reporting. Providers receive coverage determination for a complete episode of care within four to nine minutes. 

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Radiation Oncology

Our Radiation Oncology solution utilizes the most up-to-date evidence-based clinical guidelines from peer-reviewed literature, professional societies, and leading cancer physician experts to ensure that patients achieve optimal clinical and financial outcomes. The solution connects patients to the care they need by utilizing an innovative technology that minimizes the provider’s required administrative time to capture only the necessary clinically relevant information. Using our solution, providers can receive approval for a complete episode of care in as little as four minutes. 

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EviCore’s Radiology solution delivers cost savings and improved patient outcomes by ensuring health plan members receive the appropriate test or treatment necessary for their individual case presentation or condition. As a result, EviCore helps reduce inappropriate utilization, unnecessary radiation exposure, and invasive procedures.  EviCore’s approach is not to deny care that is needed but rather to redirect providers and patients to more appropriate testing and treatment options, to improve patient safety, and maximize value. 

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Lab Management

EviCore’s Laboratory Management solution utilizes test-specific current medical policies (clinical guidelines) and prior authorization guidelines to improve the quality of care and reduce genetic-testing costs. This solution helps ensure that our health plan clients pay the right amount, on the right claim, for the appropriate test. The core components of this solution are Medical Policy, Prior Authorization, Claims Integrity, and Lab Network. 

Frequently Asked Questions

Our integrated and proven EviCore onConnectSM suite includes the following:

  • The EviCore Medical Oncology, Radiation OncologyGenomic and Molecular Laboratory, and Radiology solutions
  • Radiology and Lab include all diagnoses, not just oncology
  • NCCN® and EviCore evidence-based clinical guidelines for all cancer types
  • Multi-specialty coordination for better patient outcomes
  • Consistent processes and clinical policy coordination for simplified provider experience
  • Regimen-based, dynamic clinical decision support includes all therapeutic and supportive cancer drugs from both pharmacy and medical benefits
  • Post-service, pre-payment claims review via Claims Studio.
  • Single vendor accountability
  • Synergistic program effects

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