As we noted in last month’s issue, Harvard Pilgrim will be launching a new oncology and radiation oncology medical management program with a vendor partner, Oncology Analytics. For dates of service beginning Sept. 1, 2020 for our commercial and Medicare Advantage members, prior authorization will be required for outpatient chemotherapy (infused and/or injected) and radiation therapy.
Sign up for a webinar
Oncology Analytics is offering webinars throughout August for providers and office staff to provide an overview of the program, learn about using their portal to request authorization, and answer any questions. For more information and to sign up for a session, please refer to this webinar flyer.
For this program, 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. In addition to National Coverage Determinations and Local Coverage Determinations for Medicare, Oncology Analytics utilizes current, evidence-based, disease-specific analytics on all cancer types and treatment options, backed by board-certified oncologists, radiation oncologists, and oncology pharmacists.
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
Oncology Analytics will begin accepting authorization requests on Aug. 10 for outpatient chemotherapy and radiation oncology services with effective dates of Sept. 1 and beyond. Providers may request authorization from Oncology Analytics via:
- Online —Submit requests online to Oncology Analytics via HPHConnect’s single sign on feature for both commercial and Medicare Advantage members. Access the single sign on link by logging into HPHConnect and selecting the “Oncology Analytics” link in the Office Management drop down.
- 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)
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.
Director, Network Operations