Oncology Auth. Program Begins Sept. 1

As we’ve noted in previous issues of the newsletter, for dates of service beginning Sept. 1, 2020 for our commercial and Medicare Advantage members, prior authorization will be required through Oncology Analytics for outpatient chemotherapy (infused and/or injected) and radiation therapy.

Oncology Analytics will conduct medical review of chemotherapeutic protocols (chemotherapy, support and symptom management drugs) and radiation treatment plans for commercial and Medicare Advantage members with a cancer diagnosis that requires these services. For more information, please refer to the Oncology Analytics review criteria, which you can access in the Medical/Clinical Policies section of the Harvard Pilgrim provider website or directly on the Oncology Analytics website.

Medical drug authorization program reminder

Please keep in mind that some of the drugs in the new oncology program currently require prior authorization from CVS-Novologix, as part of our medical drug management program for our commercial members. As of Sept. 1, those drugs will require prior authorization from Oncology Analytics instead — when used for oncology purposes. However, if the drug is being used to treat other conditions for our commercial members, it will still require authorization from CVS-Novologix. Please refer to the Medical Drug Prior Authorization page to view the medical drugs in that program as well as the medical review criteria.

Requesting authorization and submitting claims

Servicing providers may request authorization from Oncology Analytics via:

  • Fax — Fax your request and clinical records to 800-264-6128
  • Phone — Submit requests by calling 877-222-2021 (with any necessary clinical documentation faxed to the number above and appropriate reference number included)
  • Online — Single sign on will soon be available via HPHConnect. Sign in to HPHConnect (https://hphcproviders.healthtrioconnect.com/) and select the “Oncology Analytics” link in the Office Management drop down.

For patients under age 18, authorization requests should be submitted by fax. Fax a completed Pediatric Oncology Prior Authorization Request Form to 800-264-6128. You may access the form on https://www.oncologyanalytics.com/ under “Helpful Links” or by calling 877-222-2021 to request one.

Publication Information

Helen Connaughton,
Director, Network Operations

Annmarie Dadoly,

Joseph O’Riordan,

Kristin Edmonston,
Production Coordinator