For members enrolled in AmeriHealth Pennsylvania and New Jersey commercial products, the Company requires precertification/preapproval through CareCore National, LLC d/b/a eviCore healthcare (eviCore) to manage requests for select outpatient, non-emergent radiation therapy services using the eviCore Radiation Therapy Clinical Guidelines* to determine medical necessity. For more information about the radiation therapy services that require precertification/preapproval, refer to the current version of medical policy.#09.00.56: Radiation Therapy Services.
* eviCore utilizes multiple sources to develop their Radiation Therapy Clinical Guidelines, including consultation with the Company, evidence-based guidelines, and recommendations from national and international medical societies, and evidence-based medicine research centers, including, but not limited to, American Society of Radiation Oncology [ASTRO], National Comprehensive Cancer Network [NCCN], and American College of Radiology [ACR].
To access the eviCore Radiation Therapy Clinical Guidelines, click here and scroll down to select the criteria that is specific to AmeriHealth.
