Evolent to Manage Oncology Prior Authorization Review

Beginning May 1, 2026, Evolent will manage medical and radiation oncology authorization requests for some Highmark members* as the first phase in our oncology value-based care strategy.

Evolent is highly aligned with Highmark’s strategy to improve clinical outcomes and is uniquely positioned to help providers navigate an increasingly complex oncology environment.

What This Means for Oncology Providers

Evolent’s high-touch model will give oncology providers the ability to:

• Work directly with a dedicated and accessible Evolent engagement team to answer questions and address issues.
• Obtain real-time approvals when selecting evidence-based treatments.
• Work with oncology physician reviewers when discussing treatment options during peer-to-peer reviews.

Evolent’s oncology clinical pathways do not need to replace third-party pathway tools providers are already using. Practices may choose to continue using their established pathways in parallel with submitting oncology authorization requests, even when Evolent is managing the review. However, by following Evolent’s pathways, practices may benefit from improved regimen-based quality and efficacy as well as faster authorization approvals.

Highmark members* to be included in Evolent’s authorization reviews are:

• Commercial fully insured; Affordable Care Act (ACA); and Medicare Advantage members in Delaware, Pennsylvania, and West Virginia
• Medicare Advantage members in New York
• Pennsylvania Child Health Insurance Program (CHIP) members

No Change to Initial Submission Process

Practices will continue to submit initial oncology authorization requests through Highmark’s provider portal, Availity Essentials, and can expect Highmark’s continued one day (on average) turnaround time.

Additional code sets may be added to our prior authorization list to reflect the multi-drug regimens that are the standard of care in oncology and support a more comprehensive medical necessity review.

For requests that go to review, providers must upload supporting clinical documentation directly to the Evolent CarePro portal at evolent.com/provider-portal.

Preparation and Guidance

Training and support will be offered in the coming months to educate providers about Evolent’s program.

To help providers prepare, Evolent will be hosting live, virtual training sessions; training dates for the program can be found at go.evolent.com/highmark-program-changes-may-1-2026. Please register via this link in advance of the session you wish to attend.

We believe this collaboration will ultimately provide a better authorization process for you and our members, leveraging the highest value, evidence-based pathways.

Questions

If you have questions about Evolent programs, email providertraining@evolent.com.

*Note: Radiation Oncology Authorization requests for Highmark Administrative Services Only (ASO) members will also continue to be requested through Availity but remain under eviCore review.

Evolent is a separate company that provides oncology utilization management services.