Evolent Prior Authorization Updates Effective June 1, 2026

Date: 02/27/26

Dear Provider,

Ambetter from Sunflower Health Plan has partnered with Evolent, a leading oncology quality management company, to implement a new prior authorization program designed to streamline administrative processes and support the delivery of high-quality, evidence-based cancer care.

Effective June 1, 2026, radiation oncology services will require a prior authorization from Evolent before being administered in either provider office, outpatient hospital or ambulatory infusion center.  Treatment plans will be reviewed using nationally recognized evidence-based guidelines.

Prior authorization requirements will apply to Ambetter adult members, ages 18 and older, for ordering provider oncology specialties:

• Gynecology Oncology
• Hematology Oncology
• Medical Oncology
• Neuro Oncology
• Radiation Oncology
• Surgical Oncology
• Urology

Evolent offers providers:

• Real-time authorizations for approvable treatment plans submitted via the Evolent on-line portal evolent.com/provider-portal.
• A telephonic option for requests at 1-888-999-7713, (Radiation Oncology, option 3). Staff are available Monday-Friday, from 7:00 a.m. to 7:00 p.m. CST.
• Real-time member eligibility verification through the Evolent CarePro portal prior to entering a treatment plan.
• Radiation oncologists on staff for clinical discussions with physicians.

Ambetter approvals issued before June 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. Radiation oncology services/treatment that did not require an authorization prior to June 1, 2026, will require an authorization from Evolent for service/treatment dates on and after June 1, 2026.

Training sessions will be scheduled for several dates beginning in May. For more details and information on registration, please visit the Evolent webpage go.evolent.com/ambetter-program-changes-june-1-2026.  Should you have any questions prior to the training sessions, please contact Evolent at 1-888-999-7713, (Option 6) or via email providertraining@evolent.com.

We look forward to offering you these programs and hope it will enhance your experience with oncology service authorizations.

Sincerely,

Ambetter from Sunflower Health Plan