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

We streamline prior authorizations by reviewing the submitted clinical information against Carelon guidelines and any health plan-specific policies, giving you one place to get the approvals your patients need.

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

• All forms of external beam radiation therapy (EBRT)
  • 3D Conformal Radiation Therapy
  • Intensity Modulated Radiation Therapy (IMRT)
  • Stereotactic Radiosurgery (SRS)
  • Stereotactic Body Radiation Therapy (SBRT)
  • Proton Beam Therapy
• Brachytherapy
• Intraoperative radiation therapy (IORT)
• Selective Internal Radiation Therapy (SIRT)
• Fractionation review for EBRT or IMRT to treat prostate, breast, and non-small cell lung cancers, as well as bone metastases

Services that may also require review:

• Image guided radiation therapy (IGRT)
• Special consults and procedures associated with radiation therapy
• Select Radiopharmaceuticals, including:
  • Lutathera: Lutetium Lu 177 dotatate
  • Pluvicto: Lutetium Lu 177 vipivotide tetraxetan
  • Xofigo: Radium 223 dichloride
  • Sodium Iodide 131: Sodium iodide I-131

*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