All PlansAdministrativeMedium impact
Evolent Oncology Auth Submissions: Managing the New Process
Highmark·Oncology, Radiation Oncology·Provider Bulletin
Effective date
May 15, 2026
We identified it
May 15, 2026
Summary
Highmark has identified and addressed common challenges with the new Evolent-managed oncology prior authorization process. The policy clarifies that the Availity Essentials portal is working correctly and explains why providers may see different statuses like 'No Authorization Required' or 'Authorization Canceled' for certain oncology services.
Action Required
Immediately: Billing team should continue submitting all oncology authorization requests through Availity Essentials portal as normal. For ASO plan verification, use Patient Registration > Eligibility and Benefits Inquiry in Availity to check for 'Funding Type = Self-Insured'. If experiencing 'member not found' errors in CarePro portal after correct data entry, contact Highmark's Clinical Services team. Track all authorization statuses in Availity and use Provider Live Chat for eligibility questions.