Medicare AdvantageAdministrativeMedium impact
Evolent Oncology Program Updates
Ambetter·NE · Oncology·Provider Bulletin
Effective date
Dec 1, 2026
We identified it
Aug 26, 2026
Summary
Effective December 1, 2026, Evolent will issue final denial determinations for oncology authorization requests that do not meet clinical criteria, replacing the current Recommended Adverse Determination (RAD) process where Ambetter Health issued final decisions. Requests received before 12/1/2026 will continue under the current RAD process. Grievances and appeals remain submitted directly to Ambetter Health.
Action Required
By November 30, 2026: Billing and prior authorization teams must update internal workflows and provider communication protocols to reflect that Evolent will now issue final denial determinations for oncology services effective 12/1/2026. Ensure oncology providers understand that denial notices will come directly from Evolent rather than through Ambetter Health. Continue submitting all grievances and appeals to Ambetter Health as before. No system changes are required for requests submitted prior to 12/1/2026, which will continue under the current RAD process. Contact Ambetter Health Provider Relations with questions about implementation.