Health Plans | Utilization Management Radiation Oncology

A pillar of eviCore’s Comprehensive Oncology suite, 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. Our solution connects patients to the care that they need by utilizing a dynamic technology that minimizes provider administrative time by capturing only the necessary clinically relevant information. Using our solution, providers can receive approval for a complete episode of care in as little as 4 minutes.

Challenges

As the population ages, an increase of new cancer cases are expected to be diagnosed. The number of patients undergoing active treatment for cancer has never been higher, the complexity of therapy options is proliferating, and patients are being treated for longer periods of time. Unfortunately, many patients do not receive a treatment plan consistent with current medical evidence, primarily due to:

  • Radiation treatment techniques without clinical evidence for specific cancer types.
  • Use of more costly therapy without evidence of superior outcomes.
  • Treatment fractions beyond what is necessary to achieve an equivalent result.

Frequently Asked Questions

What digital resources can I access to find out more information
What is included in the Radiation Oncology solution?

Our integrated and proven Radiation Oncology solution is a core component of eviCore’sComprehensive Oncology Management suite:

  • Evidence-based clinical guidelines for all cancer types
  • eviCore’s proprietary, regimen-based, utilization management application designed for provider and health-plan efficiency
  • Cost savings without the need to narrow regimens or the provider network
  • Inclusion of all appropriate treatment techniques in one episode of care
  • Electronic transmittal of approved HCPCS codes
  • Post-service, pre-payment claims review.

clinical expertise

Prior to joining eviCore healthcare, I had the privilege of spending over a decade caring for patients with cancer. During this time, I observed the field of oncology evolve rapidly with technological advancements that have helped prolong, and in many cases, cure cancer. However, clinical evidence does not always keep up with technology and sometimes the adoption of unproven forms of treatment can create financial toxicity for patients without a gain in clinical benefit. As such, it is critical to ensure that treatments and technologies are appropriately used for the right patient at the right time while being supported by published evidence and national guidelines. At eviCore healthcare, we put patient care first and, in collaboration with our clients, oncology societies, and physicians, we lay the foundation for positive patient outcomes.

Dr. Rajanish Singla Chief, Radiation Oncology

Board-Certified Radiation Oncologist