Community Care – Oklahoma: Update on Implementation of Oncology – Prior Authorization Management by Evolent
October 30, 2024
CommunityCare is excited to notify you that effective Friday, November 1, 2024, Evolent (formerly New Century Health) will begin managing prior authorizations for most oncology-related services.
As previously noted in a late July notification, the following will require a prior authorization from Evolent before being administered in either the provider office, outpatient hospital, ambulatory setting or infusion center: physician administered and oncology-related infused and injectable chemotherapeutic drugs, supportive agents, symptom management medications and radiation oncology treatment requests.
Treatment plans will be reviewed using nationally recognized evidence-based guidelines and not be more restrictive than CMS criteria.
Prior authorization requirements will apply to all CommunityCare Commercial and Marketplace members of all ages and Medicare Advantage members 18 years of age and older.
Please note the following:
• Real-time authorizations for treatment plans meeting best evidence-guided therapy may be submitted via the Evolent CarePro provider portal at https://my.newcenturyhealth.com.
o The Evolent CarePro provider portal may also be accessed from a link in the CommunityCare provider portal, CareWeb.
• Authorization status updates will be available in the Evolent CarePro provider portal.
o After determination, authorizations will also show in CommunityCare’s provider portal, CareWeb.
• Telephone authorization requests – Providers needing to request an authorization may call 1-888-999-7713, (Oncology – Option 2) (Radiation Oncology – Option 3). Staff are available Monday-Friday, from 7 a.m. to 7 p.m. CST
• Oncologists and radiation oncologists are on staff for clinical discussions with physicians.
• A dedicated Evolent Provider Solutions Manager is available to contact directly for any issues or questions.
All prior authorizations for surgical oncology treatment after November 1, 2024, should be directed to CommunityCare via the CareWeb portal.
Any CommunityCare prior authorizations approved before November 1, 2024, are effective and valid until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. For services/treatment that did not require an authorization prior to November 1, 2024, an authorization may be required from Evolent for service/treatment dates on and after November 1, 2024.
If your office has not been contacted by an Evolent Provider Solutions Manager to schedule an introductory meeting and training session to prepare users for the upcoming transition, please contact Evolent at 1-888-999-7713, (Option 6) or via email at .
If you have questions, please contact CommunityCare’s Medical Management department at (918) 594-5228 or (800) 594-0089 or contact your Provider Services Representative.
Cigna – Demographic data updates for providers in Colorado, District of Columbia, and Illinois
October 08, 2024
Earlier this year, we began a partnership with LexisNexis®1 Risk Solutions to help ensure we remain compliant with local and federal data validation mandates and that our provider directory remains accurate.
What this means to you
Beginning October 4, 2024, your office may receive phone calls from a LexisNexis Risk Solutions representative identifying themselves as being affiliated with Cigna HealthcareSM. Please be assured that these calls are authorized by Cigna Healthcare and are not spam.
The LexisNexis Risk Solutions representative will request confirmation of specific demographic information, which may include, but not be limited to, the following:
Office address/phone number.
Billing address/phone number.
National Provider Identifier.
Tax Identification Number.
Additional information We appreciate your partnership in this critical effort to help ensure the collective accuracy of provider data, which ultimately helps your patients with Cigna Healthcare coverage find you when they need care.
For any questions, please call Cigna Healthcare Provider Service at 800.88Cigna (882.4462).
Cigna – EviCore by Evernorth to manage precertification for molecular laboratory tests beginning November 1
September 25, 2024
Sign up for online orientation sessions.
Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for molecular laboratory tests for Cigna Healthcare℠ customers.
What this means to you
Obtain precertification for molecular laboratory tests from EviCore by:
Website: EviCore.com/Provider
Telephone (866.668.9250)
Fax (855.774.1319)
Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*
Online learning sessions
Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:
Click “Register” next to the session you wish to attend.
Enter the registration information.
After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.
If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.
Additional information
For more information about precertification for molecular laboratory tests, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.
Cigna – EviCore to manage precertification for vascular intervention procedures beginning November 1
September 25, 2024
Sign up for online orientation sessions.
Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for vascular intervention procedures for Cigna Healthcare℠ customers.
What this means to you
Obtain precertification for vascular intervention procedures from EviCore by:
Website: EviCore.com/Provider
Telephone (866.668.9250)
Fax (855.774.1319)
Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*
Online learning sessions
Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:
Click “Register” next to the session you wish to attend.
Enter the registration information.
After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.
If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.
Additional information
For more information about precertification for vascular intervention, access the resources available at available at EviCore.com/Resources/HealthPlan/Cigna.
Cigna – EviCore by Evernorth to manage precertification for spine surgery beginning November 1
September 25, 2024
Sign up for online orientation sessions.
Beginning November 1, EviCore by Evernorth® will manage precertification for Current Procedural Terminology (CPT®) codes for spine surgeries for Cigna Healthcare℠ customers.
What this means to you
Obtain precertification for spine surgeries from EviCore by:
Website: EviCore.com/Provider
Telephone (866.668.9250)
Fax (855.774.1319)
Cigna Healthcare will continue to manage precertification requests until October 31. On November 1, EviCore will be available to take precertification requests by telephone, fax, and via their website.*
Online learning sessions
Beginning in October, EviCore will lead online session to help you and your staff understand the new precertification process. To register for and participate in a session:
Select “Webex Training” from the menu bar on the left.
Click the “Upcoming” tab. Choose “Cigna Musculoskeletal Spine Provider Orientation.”
Click “Register” next to the session you wish to attend.
Enter the registration information.
After you have registered for the Webex session, you will receive an email containing the toll-free telephone number, meeting number, conference password, and a link to the web portion of the session. Please keep the registration email so you will have the link to the Webex and the call-in number for the session in which you will be participating.
If you are unable to participate in a session, you can obtain a copy of the presentation and other important documents at evicore.com/resources/healthplan/cigna. Documents are available in PDF format. You can download Adobe Reader from adobe.com/products/reader/.
