01Already effective March 3, 2026: Get prior authorization from Evolent before administering oncology chemotherapeutic drugs, supportive agents, symptom management medications or radiation oncology services for members with primary diagnoses in the range C00 to D49.9 or E34.0, E34.01 and E34.09.
02Requests can be submitted through the Evolent Provider Portal (select CarePro) or by phone at 1-888-999-7713, option 2 for medical oncology or option 3 for radiation oncology.
03Upload supporting clinical documentation directly to the prior authorization request.
04Presbyterian approvals issued before March 3 remain effective until the authorization end date, and oncology or radiation oncology services that did not require authorization before March 3 may require an Evolent authorization for dates of service on or after March 3.
05Billing team: From March 13, 2026, Presbyterian stops creating secondary claims for dual coverage members, so submit both primary and secondary claims.
06On all Medicaid claims, include Presbyterian Payor ID 77048 for PROVIDERConnect or approved clearinghouses, include NMPHP in Loop 2010BB (Segment NM109) for approved clearinghouses, and verify that last name and date of birth match the HCA member portal.
07HCA was scheduled to go live with Turquoise Claims on March 23, 2026, so check current applicability.
08Billing team: Bill Q3014 only when the originating site is the eligible facility where the member is physically located.
09Do not bill Q3014 when the member is at home or at a site that does not meet geographic requirements.
10Distant site providers bill only the professional service using the correct telehealth modifier or place of service.
11Originating site documentation must show the member was physically present at an eligible facility and that the site supplied space, equipment and support, and must clearly separate originating site services from distant site professional services.
12Split or shared E/M visits are billed once, under the clinician who performed the substantive portion (more than half of total time or the majority of medical decision-making), and both clinicians must document their individual contributions.
13Directory information must be verified every 90 days: physical health providers log in to the provider portal to make updates, and behavioral health providers use the behavioral health portal.
14The next deadline is stated as April 1, with no exemptions, so check current applicability.