Idaho Medicaid Updates Prior Authorization Rules for Radiation Therapy

Effective January 1, 2026, prior authorization and notification will be mandatory for outpatient chemotherapy and radiation therapy services for individuals covered under the Idaho Medicare Medicaid Coordinated Plan (MMCP). Providers should continue to submit these requests through the Optum Cancer Guidance Program (CGP), which is fully integrated with MMCP and adheres to established oncology procedures.

Radiation Therapy Services Requiring Prior Authorization

Starting January 1, 2026, some radiation therapy treatments will need prior authorization and notification before they can be provided. These include:

• Intensity-modulated radiation therapy
• Proton beam therapy
• Stereotactic body radiation therapy
• Fractions for breast, prostate, lung cancer, and bone metastasis
• Image-guided radiation therapy
• Special and associated radiation therapy services

This update is part of the Cancer Guidance Program (CGP), designed to ensure appropriate, evidence-based management of oncology service requests.

How to Submit a Prior Authorization

• Sign in to the UnitedHealthcare Provider Portal using your One Healthcare ID.
• If you don’t yet have an ID, you can register for one online.
• Once logged in, navigate to the “Prior Authorizations & Notifications” section on the left menu.
• To learn more, review the interactive guide on Prior Authorization and Notification.

Coverage and Payment Details

You can review coverage determination guidelines to understand the criteria for radiation therapy services. Please note that an approved prior authorization does not guarantee payment. All claims are subject to:

• Member eligibility at the time of service
• Individual benefit plan terms
• Standard claim processing requirements
• Applicable provider participation agreements

Additional Resources

For more details, live training sessions, and ongoing updates, visit the Oncology Prior Authorization and Notification resources page.