Updates to timelines and authorization requirements for OncoHealth expansion supersede previous Operations Bulletin

 

*“All plans” includes Geisinger Gold (Medicare), Geisinger Health Plan commercial, GHP Family (Medicaid) and GHP Kids (CHIP). Authorization requirements for self-funded plans for which Geisinger Health Plan acts as third-party administrator may differ.

 

• Authorizations previously issued by Geisinger Health Plan before the implementation dates will be effective until the authorization expiration date.
• As of the effective dates stated above, new authorization requests for the types of drugs, therapies and plans listed above must be submitted through OncoHealth.

What you should do before October to prepare

Watch for outreach from OncoHealth. Their provider relations team will soon share information on a webinar series and training that will give you an overview of OncoHealth, how the oncology management program works and what you can expect from it.

Join an OncoHealth webinar to learn more

OncoHealth will host webinars through Zoom Tuesdays and Thursdays, Aug. 27 through Sept. 26. Use the links below to register for a morning or afternoon session.

• Morning webinar ­–Tuesdays at 11 a.m. ET
• Afternoon webinar – Thursdays at 2 p.m. ET

How to request authorization

Request an authorization for radiation oncology therapy or medical benefit chemotherapeutic drugs using one of the following methods: 

• Web: oneum.oncohealth.us
• Fax:800-264-6128           
• Phone:888-916-2616
  

How to confirm authorization

• Ordering providers: A dashboard inside of OncoHealth’s provider portal, OneUM, makes it easy to view the status of your prior authorization requests.
• Servicing providers: Upon determination, a notification is sent to the servicing provider from OncoHealth.

Have questions?

• For questions on submitted requests, requesting reconsideration, making updates to a case or to talk with a provider or nurse about a case, call 888-916-2616 or email info@oncohealth.us.
• Fax additional requested information or medical records and lab results to 800-264-6128.
• For questions about credentials, system access or any technical issues before submitting a prior authorization request, email clientsupport@oncohealth.us.
• OncoHealth will conduct training sessions to familiarize providers with the process. Visit OncoHealth online today to find a learning opportunity that works for your schedule.

Changes to radiation oncology therapy authorization requirements

As of Dec. 2, OncoHealth will manage prior authorization for radiation oncology therapy for cancer and benign tumors. Below is a list of procedures that will require prior authorization through OncoHealth:

55875 Transperi needle place pros
55876 Place rt device/marker pros
76873 Echograp trans r pros study
76965 Echo guidance radiotherapy
77014 Ct scan for therapy guide
77261 Radiation therapy planning
77262 Radiation therapy planning
77263 Radiation therapy planning
77280 Set radiation therapy field
77285 Set radiation therapy field
77290 Set radiation therapy field
77293 Respirator motion mgmt simul
77295 Set radiation therapy field
77299 Radiation therapy planning
77300 Radiation therapy dose plan
77301 Radiotherapy dose plan imrt
77306 Telethx isodose plan simple
77307 Telethx isodose plan cplx
77316 Brachytx isodose plan simple
77317 Brachytx isodose intermed
77318 Brachytx isodose complex
77321 Special teletx port plan
77331 Special radiation dosimetry
77332 Radiation treatment aid(s)
77333 Radiation treatment aid(s)
77334 Radiation treatment aid(s)
77336 Radiation physics consult
77338 Design mlc device for imrt
77370 Radiation physics consult
77371 Srs multisource
77372 Srs linear based
77373 Sbrt delivery
77385 Ntsty modul rad tx dlvr smpl
77386 Ntsty modul rad tx dlvr cplx
77387 Guidance for radj tx dlvr
77399 External radiation dosimetry
77401 Radiation treatment delivery
77402 Radiation treatment delivery
77407 Radiation treatment delivery
77412 Radiation treatment delivery
77417 Radiology port film(s)
77423 Neutron beam tx complex
77424 Io rad tx delivery by x-ray
77425 Io rad tx deliver by elctrns
77427 Radiation tx management x5
77431 Radiation therapy management
77432 Stereotactic radiation trmt
77435 Sbrt management
77469 Lo radiation tx management
77470 Special radiation treatment
77499 Radiation therapy management
77520 Proton trmt simple w/o comp
77522 Proton trmt simple w/comp
77523 Proton trmt intermediate
77525 Proton treatment complex
77600 Hyperthermia treatment
77605 Hyperthermia treatment
77610 Hyperthermia treatment
77615 Hyperthermia treatment
77620 Hyperthermia treatment
77750 Infuse radioactive materials
77761 Apply intrcav radiat simple
77762 Apply intrcav radiat interm
77763 Apply intrcav radiat compl
77767 Hdr rdncl skn surf brachytx
77768 Hdr rdncl skn surf brachytx
77770 Hdr rdncl ntrstl/icav brchtx
77771 Hdr rdncl ntrstl/icav brchtx
77772 Hdr rdncl ntrstl/icav brchtx
77778 Apply interstit radiat compl
77789 Apply surface radiation
77790 Radiation handling
77799 Radium/radioisotope therapy
0394T Hdr elctrnc skn surf brchytx
0395T Hdr elctr ntrst/ntrcv brchtx
C1716 Brachytx, non-str, gold-198
C1717 Brachytx, non-str,hdr ir-192
C2616 Brachytx, non-str, yttrium-90
G0339 Robot lin-radsurg com, first
G0340 Robt lin-radsurg fractx 2-5
G0458 Ldr prostate brachy comp rat
G0463 Hospital outpt clinic visit
G6001 Echo guidance radiotherapy
G6002 Stereoscopic x-ray guidance
G6003 Radiation treatment delivery
G6004 Radiation treatment delivery
G6005 Radiation treatment delivery
G6006 Radiation treatment delivery
G6007 Radiation treatment delivery
G6008 Radiation treatment delivery
G6009 Radiation treatment delivery
G6010 Radiation treatment delivery
G6011 Radiation treatment delivery
G6012 Radiation treatment delivery
G6013 Radiation treatment delivery
G6014 Radiation treatment delivery
G6015 Radiation tx delivery imrt
G6016 Delivery comp imrt
G6017 Intrafraction track motion

About OncoHealth

OncoHealth offers providers, patients and health plans an evidence-based, technology-driven approach to medical oncology management. OncoHealth supports providers in the United States and Puerto Rico, providing patients with the ability to achieve the best possible outcomes in their cancer care. This has been accomplished by facilitating the continuous access to current, evidence-based, disease-specific analytics on all cancer types, stages and treatment options, backed by our board-certified oncologists/hematologists, radiation oncologists, pharmacists and nurses. OncoHealth promotes evidence-based treatments that consider all therapeutic options based upon objective assessments of efficacy, safety and cost-effectiveness.

Comprehensive cancer support through Iris by OncoHealth

Iris by OncoHealth delivers a seamless cancer treatment experience that prioritizes members’ individual needs and can complement your patients’ care plans. Iris offers members a wide variety of services, including:

• 24/7 oncology nursing
• Behavioral health support
• Nutrition programs
• Resource navigation

Learn more at oncohealth.us/iris.