News
Evolent to Administer Wellcare Indiana Oncology Program
Date: 08/27/26
Effective 11/01/2026
Wellcare Indiana (Medicare) is expanding its collaboration with Evolent as the administrator of its Oncology Quality Management (OQM) program.
Effective November 1, 2026, prior authorization from Evolent is required for the following items before being administered in a provider office, outpatient hospital, or ambulatory surgical center:
- Radiation oncology services
- Oncology-related infused chemotherapeutic drugs
- Supportive agents and symptom management medications
The Evolent oncology program will apply to gynecologic, medical, neurological, radiation, and surgical oncology, as well as hematology and urology, for the following diagnoses for Wellcare Indiana members 18 years of age and older.
Diagnoses | Associated ICD-10 Codes |
Cancer/Oncology-related | C00 - D09, D37 - D44, E34.0 |
Hematology | 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 and Vomiting | R11 |
In addition to treatment plan reviews using nationally recognized evidence‑based guidelines, the Evolent partnership also provides:
- Real-time authorizations for evidence-based treatment plans submitted through the Evolent online CarePro provider portal.
- Eligibility verification available directly in the portal prior to submitting a treatment plan.
- Submission of treatment plans via phone (when needed) by calling 1-888-999-7713.
- Radiation oncology and medical oncology physicians on staff to conduct physician discussions.
Approvals issued before November 1, 2026 are effective until the authorization end date, and will then require authorization requests to be submitted to Evolent, or claims may be denied. Services/treatments that did not require authorization prior to November 1, 2026, may require authorization from Evolent for service/treatment dates on and after November 1, 2026.
Informational training sessions will be scheduled for several dates in October. Visit the Evolent webpage for training information, and email Evolent at practicesuccess@evolent.com for assistance with training questions.
Additional details will be provided closer to the implementation date. If you have questions, please contact the Wellcare Indiana Provider Services department at 1-877-647-4848.