06/17/2020

BCBSM/eviCore Launching a new Radiation Oncology Clinical Decision Support PA Model

BCBSM/eviCore launching a new Radiation Oncology Clinical Decision Support (CDS) PA model to simplify and speed the provider experience.  The first phase of CDS launches on July 1st, 2020 and includes breast, non-small cell lung, and prostate cancers. eviCore’s pilot of the CDS model succeeded in reducing the number of clinical questions required for prior authorization by up to 92% while preserving program efficacy. eviCore will add additional cancer types to the CDS model in subsequent phases, on an approximately quarterly basis.
 
The eviCore Provider Engagement team will coordinate education to providers and provide a guide for Frequently Asked Questions.
 
CLICK HERE to view the presentation which outlines eviCore’s Radiation Oncology CDS model. 
 
Some notes below from the attached presentation.
 
Why is eviCore transitioning Radiation Oncology to CDS?
• Improve the prior authorization process for providers 
• Reduce clinical questions by up to 92%! 
• Guide providers to a list of approvable treatment regimens 
• Align Radiation Oncology with the Medical Oncology program design
 
What are the key differences with the Clinical Decision Support model? 
• The provider web portal login and demographic question/answer process is not changed 
• There will be far fewer clinical questions during the prior authorization process 
• After the clinical questions, providers will receive a list of regimen options from which to select
 
How do Providers access the new Clinical Decision Support process?
• Log into the eviCore provider web portal as normal: www.eviCore.com
• Initiate a request for Clinical Certification for Radiation Therapy, as normal 
• Complete the demographic questions, as normal 
• For breast, prostate, and non-small-cell lung cancer cases, the CDS clinical questions will automatically replace the traditional clinical questions; there is nothing new that providers have to do to trigger them