Three tips to streamline your medical oncology and chemotherapy submissions

As cancer treatments become increasingly targeted, authorization submissions require more-specific clinical detail. The tips below apply to both physicians documenting in clinical notes and authorization staff preparing submissions.

• For physicians: Including all the information noted in the following tips in your clinical notes can help reduce clarification requests and peer-to-peer calls.
• For authorization staff: The following tips provide information on the most common submission errors and omissions. If you identify one or more of these in a case you are working on, it may be worth checking with the ordering physician before submitting the case.

Tip 1: Submit Complete Test Results.

Many oncology drugs are approved only for patients with specific test results. When the case build asks about test results—such as histology, pathology subtype or molecular testing, include exact values and scores.

This information is typically required to complete the authorization review, and missing results can lead to clarification requests and delays.

Tip 2: Submit the Full Drug Regimen.

Incomplete drug information is one of the most common causes of delays or non-certifications.

List all agents in the regimen, including oral medications, even if a specific drug does not require prior authorization or is handled by a different authorization team. A complete regimen listing supports accurate review and helps avoid unnecessary follow-up.

Tip 3: Submit Each Regimen Under Its Specific Cancer Diagnosis.

When a patient is being treated for more than one type of cancer simultaneously, each diagnosis requires its own separate case submission. Avoid grouping multiple regimens under a single diagnosis.

• Build a separate primary treatment case for each cancer diagnosis.
• Submit supportive drug cases under the specific primary treatment and diagnosis they support.