Approve a treatment plan

After we review a treatment plan, if we think that there are medically justified reasons that the treatment plan deviates from evidence-based care or your health plan language, we provide you with all of the documentation and request your approval before we assign the treatment plan an Eviti code.

A treatment plan may deviate, for example, if the patient cannot follow the regimen exactly. The patient may live far from the hospital and cannot get to the hospital for treatments as often as the regimen specifies. Although the patient cannot follow the best practice for the regimen, we think it's appropriate care and that you should approve the treatment plan.

Additionally, we request that you approve most clinical trials so you can review the costs that the trials pay versus what you must pay.

All treatment plans that require your approval appear in the Approval Req'd tab, with Authorize and Decline links in the Payer Actions column.

To review the treatment plans that require your approval, follow these steps:
  1. Access the Payer Dashboard, and then click the Approval Req'd tab.
  2. Review the details of the treatment plan.
  3. After you determine whether to authorize or decline the treatment plan, in the Payer Action column, click Authorize or Decline.
  4. In the screen that appears, enter notes about your decision in the Notes box, and then click Authorize or Decline.
    • If you authorize the treatment plan, the system assigns it an Eviti code, and moves it to the Eviti Code and All Records tabs.
    • If you decline the treatment plan, the system does not assign it an Eviti code, and moves it to the Code Denials and All Records tabs.
  5. Follow your organization's steps to complete the authorization.