Oncology Program
OncoHealth administers the Sentara Health Plans (SHP) Oncology Benefits Management Program. The program includes support for prior authorization management of all SHP commercial, Medicaid and Medicare lines of business for members with a cancer diagnosis that requires chemotherapeutic drugs [oral and infusion], symptom management drugs, supportive agents, radiation therapy drugs and molecular genetic testing. Learn more about OncoHealth, www.oncohealth.us.
The Genetic Testing Management (GTM) program, executed in partnership with Avalon, includes new and revised medical policies, a new authorization request process, guidelines, and consistent preservice reviews for certain genetic testing services that will be applicable to both ordering and rendering provider partners.
Avalon focuses on provider education both pre- and post-determination. Avalon reviews for medical necessity and focuses on correct coding by reviewing if the code appropriately represents the test being requested. If not, we attempt to educate the providers on those components. By combining both review processes, --medical necessity, and coding—we will ensure that the correct service is identified and determined to be clinically appropriate according to evidence-based specialty lab guidelines and best practices. Learn more.