We require authorization or pre-approval for inpatient requests for cancer treatment services for all members. Notification to Blue Cross is required. Go to our Prior Authorization Overview page for tips for submitting authorization requests.For FEP members, please check authorization requirements at fepblue.org.
We require prior authorization for certain outpatient medical oncology and radiation oncology services through our Quality Care Cancer Program. The program is administered by Carelon Medical Benefits Management (formerly AIM Specialty Health), an independent company, so authorization requests should go directly to them.
Note: Indemnity members are not part of the Quality Care Cancer Program.
Outpatient medical oncology services and supportive care medications as noted in our medical policies:
Radiation oncology services as noted in our medical policies:
Ordering providers will request authorization with Carelon in one of three ways:
Medical oncology services
Most order request also may require:
For order entry worksheets and checklists, click here.
Radiation oncology services
Clinical data required:
After entering and reviewing your request, you’ll receive a summary. Approved orders will indicate “Authorized” and will include an “Order ID.” You’ll also see a summary of codes and disease information.
To avoid a denied claim, servicing providers should use the Carelon's ProviderPortal to verify that an authorization is in place before the service is performed.
S-code Fact Sheet (log in required )
Federal Employee Program (FEP) members are not included in the Quality Care Cancer Program, but they may have authorization or pre-certification requirements for their outpatient cancer services. To check authorization requirements, please visit fepblue.org.