Carelon Medical Benefits Management recognizes the key role that radiation oncology practices play in the delivery of care for patients with cancer. Developed in collaboration with your patients’ health plans, our Radiation Oncology program helps support quality care that is consistent with current medical evidence. And that’s good news for your practice and the patients you serve.

Our process

Based on the clinical information you submit, we conduct a clinical appropriateness review of your requests against clinical guidelines and health plan medical policies, providing you with a central location to obtain authorizations required by your patients’ health plans.

Our review process encompasses certain radiation therapy treatments including, but not limited to*:

• Intensity Modulated Radiation Therapy (IMRT)
• 3D Conformal/ External Beam Radiation Therapy (EBRT)
• Stereotactic Radiosurgery (SRS)/Stereotactic Body Radiation Therapy (SBRT)
• Brachytherapy
• Proton Beam Therapy

Services that may also require review:

• Fractions (number of treatments) for patients with breast cancer, lung cancer or bone metastases when requesting EBRT and IMRT
• Image guided radiation therapy (IGRT)
• Special consults and procedures associated with radiation therapy
• Radiopharmaceuticals, including Ibritumomam tiuxetan, Lutetium Lu 177 dotatate, and Radium 223 dichloride

*Note: procedures reviewed may vary by health plan

Everyone I know that uses the online portal thinks it is the easiest one in the industry to use. And your clinical reviewers are always kind and make our jobs easy.

- Provider practice feedback