All PlansAdministrativeMedium impact
Evolent Oncology Program Updates Effective October 1, 2026
Ambetter·Oncology, Radiation Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Aug 26, 2026
Summary
Effective October 1, 2026, Evolent will issue final denial determinations for oncology authorization requests that do not meet clinical criteria, replacing the previous process where Ambetter Health issued final determinations. For requests received before October 1, 2026, Evolent will continue issuing Recommended Adverse Determinations (RADs) with Ambetter Health providing final determination. Grievances and appeals continue to be submitted directly to Ambetter Health.
Action Required
By September 30, 2026: Billing team must update internal workflows and staff training to understand that oncology authorization denials from Evolent will now be final determinations rather than recommendations requiring Ambetter Health confirmation. Update appeal procedures to reflect that denials issued on or after October 1, 2026 should be appealed to Ambetter Health per standard appeal processes. For all requests submitted before October 1, 2026, continue current procedures where Evolent issues RADs and Ambetter Health provides final determination. Ensure providers and billing staff understand the new denial workflow to avoid processing delays. Contact Evolent at 1-888-999-7713 or practicesuccess@evolent.com with questions about specific denials.