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Wellcare by Allwell - Evolent Radiology Oncology Notice

Date: 07/30/26

Wellcare by Allwell cares about our members’ health. That’s why we continually enhance our programs to improve quality of care. We are pleased to announce we are expanding our collaboration with Evolent as the administrator of the Wellcare by Allwell Oncology Quality Management program (OQM). 

Effective November 1, 2026, radiation oncology services and oncology-related infused chemotherapeutic drugs, supportive agents and symptom management medications will require a prior authorization from Evolent before being administered in either provider office, outpatient hospital or ambulatory surgical center.     

The Evolent oncology program will apply to the specialties of gynecologic oncology, hematology, medical oncology, neurological oncology, radiation oncology, surgical oncology and urology for the following diagnoses and associated ICD-10 codes for your Wellcare by Allwell Medicare members age 18 years and older:   

  • Cancer diagnoses: C00–D09, D37–D44, E34.0   

  • Hematology diagnoses: D45–D49, D59.10–D59.19, D61.81, D61.82, D63.0, D63.8, D64.2–D64.3, D64.81, D64.89, D64.9, D68.59, D69.3, D69.41, D69.59, D69.6, D69.8, D69.9, D70.1–D70.9, D72.8, D72.9, D73.81, D73.9, D75.1, D75.81, D75.82   

  • Nausea & vomiting: R11   

Treatment plans will be reviewed using nationally recognized, evidence‑based guidelines. We hope you will find value in the enhancements coming with the Evolent partnership: 

  • Real-time authorizations for evidence-based treatment plans submitted through the Evolent online CarePro provider portal at Evolent.com/provider-portal 

  • Eligibility verification available directly in the portal prior to submitting a treatment plan 

  • Telephonic intake option, available for submitting treatment plans when needed by calling 1-888-999-7713 

  • Radiation oncology and medical oncology physicians on staff to conduct physician discussions 

Wellcare by Allwell approvals issued before November 1, 2026 are effective until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. If authorization is not obtained from Evolent, claims may be denied. For services/treatment that did not require an authorization prior to November 1, 2026, an authorization may be required from Evolent for service/treatment dates on and after November 1, 2026. 

Introductory informational training sessions will be scheduled for several dates in October. For more details and information on registration, please visit Evolent’s webpage at Go.Evolent.com/wellcare-program-changes-November-1-2026. If you have any questions prior to the training sessions, please contact Evolent at PracticeSuccess@evolent.com.   

We will provide additional information as we approach the implementation date. If you have questions, please contact Wellcare by Allwell’s Provider Services team at  
1-800-977-7522 (TTY: 711). We look forward to offering you these programs and hope it will enhance your experience with oncology service authorizations.