We’re making a change in how some groups handle preauthorizations for proton beam therapy

Effective Jan. 1, 2018, eviCore healthcare will handle proton beam therapy preauthorizations for some of our commercial PPO members.

To obtain preauthorization for a patient you’re scheduling for proton beam therapy, follow these steps:

Log in to Provider Secured Services and go to web-DENIS.
Under Subscriber Info on the left side of the page, click on Eligibility/Coverage.
Select Prior Authorization.
Enter the provider NPI and contract number for the member. Programs requiring prior authorization for that member will appear.
Select the appropriate program for your member.
Sign on to select the vendor. (Web-DENIS will direct health care providers to the appropriate vendor for their member, which will be either eviCore or AIM, depending on their contract.)

Note: Federal Employee Program^® members and State of Michigan and UAW Retiree Medical Benefits Trust groups are excluded from this program. MESSA is also excluded and will continue with AIM.

These are the proton beam therapy codes that will require preauthorization:

*77520
*77522
*77523
*77525

For more information about how to determine preauthorization, see the November Record article titled “Here’s more information about determination, training for new preauthorization program for commercial PPO.”

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2016 American Medical Association. All rights reserved.