CommercialAdministrativeMedium impact
Evolent Oncology Program Updates Effective Oct, 1 2026
Ambetter·MI · Oncology·Provider Bulletin
Effective date
Oct 1, 2026
We identified it
Aug 29, 2026
Summary
Effective October 1, 2026, Evolent will issue final denial determinations (instead of recommendations) for oncology authorization requests that do not meet clinical criteria. For requests submitted before 10/1/2026, Evolent will continue issuing Recommended Adverse Determinations (RADs) with Ambetter from Meridian providing final determination. Grievances and appeals remain directed to Ambetter from Meridian.
Action Required
By September 30, 2026: Billing and prior authorization team must update internal workflows and communication protocols to reflect that Evolent will now issue final denial determinations for oncology services (not recommendations) effective 10/1/2026. Ensure all staff understand that: (1) Requests received before 10/1/2026 continue under current RAD process with Ambetter providing final determination; (2) Requests received on/after 10/1/2026 will receive final denials directly from Evolent; (3) All grievances and appeals must still be submitted to Ambetter from Meridian. Update authorization request tracking systems and staff training materials. Contact your Provider Engagement representative at Ambetter if clarification needed on transition procedures.