☢️ Radiation Oncology · Montana · Beta

Prior Auth Shouldn't
Delay Cancer Treatment

White Rabbit checks your radiation oncology cases against each payer's exact criteria — before you submit — so documentation gaps don't stand between your patients and their treatment.

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$30K–80K

Avg SBRT Course Value

Montana Payers Covered

Cancer Sites · 20+ Combos

6-Step

Guided Wizard

The Problem

Rad onc denials are preventable.
Most practices don't know until after.

Payer reviewers follow strict eligibility checklists — NCCN categories, SBRT framing criteria, technique justification thresholds. A single missing element triggers a denial that delays care and costs weeks.

73%

Of Rad Onc Denials Are Technique-Based

The treatment was clinically appropriate. The documentation didn't prove why the requested technique was necessary over a less intensive alternative. SBRT vs conventional, IMRT vs 3D-CRT — payers want a documented reason every time.

21+ Days

Average Appeal Cycle for a Denied Radiation Case

Unlike surgical cases where you can reschedule, radiation oncology delays directly interrupt a treatment course in progress — or force a patient to start without authorization and absorb the financial risk.

$220K+

Estimated Annual Revenue at Risk per Physician

Conservative estimate based on 4–6 preventable denials per month across SBRT, IMRT, and advanced technique cases at average course values in a Montana market with limited peer-to-peer leverage.

How It Works

A six-step wizard built
for how rad onc PA actually works

Unlike a simple note-paste tool, White Rabbit's wizard first establishes the clinical context — site, stage, intent, technique, payer — before evaluating the documentation. This means the tool checks exactly the right criteria for your specific case combination.

Cancer Site

Prostate, Breast, Lung, or Bone Mets

Stage

Risk group or TNM staging

Intent

Definitive, adjuvant, or palliative

Technique

SBRT, IMRT, SRS, proton & more

Payer

7 Montana payers covered

Analyze

Paste note → instant gap report

💡

Why the wizard matters: In radiation oncology, the authorization criteria depend entirely on the site × technique combination. Lung SBRT for a medically inoperable patient has completely different requirements than IMRT for a locally advanced case — even at the same stage. The wizard constrains the AI to check exactly the right criteria for your specific case before it ever reads the note. No wasted flags. No missed critical items.

Cancer Sites Covered

Four sites. Every major technique.
Every common denial trigger.

White Rabbit covers the four highest-volume, highest-denial-rate radiation oncology scenarios — with site-specific, technique-specific, payer-specific criteria built in.

🫀

Prostate

6 risk groups · 5 techniques · Definitive, adjuvant & salvage

Top denial triggers

SBRT eligibility not documented (prostate volume, IPSS, no recent TURP)

Proton: dosimetric comparison to IMRT missing or insufficient

ADT plan absent for high-risk / unfavorable intermediate per NCCN

NCCN risk group not explicitly stated in documentation

IMRT / VMAT SBRT / Hypofrax Proton Therapy HDR Brachy Boost LDR Brachy

🎗️

Breast

5 stages · Post-lumpectomy, PMRT & palliative

Top denial triggers

APBI: ASTRO suitability criteria not fully documented (8 required elements)

Whole breast IMRT: dosimetric rationale vs 3D-CRT absent (BCBS/Premera)

Regional nodal RT: nodal involvement documentation insufficient

PMRT: post-mastectomy indications not explicitly stated

Whole Breast 3D-CRT Whole Breast IMRT APBI Regional Nodal IMRT Post-Mastectomy IMRT

🫁

Lung / Thoracic

4 stages · SBRT, concurrent chemoRT & palliative

Top denial triggers

SBRT: surgical consultation & PFT documentation missing — critical for medical inoperability

Concurrent chemoRT: ECOG >1 without justification triggers denial

Motion management plan (4D CT / gating) not documented for SBRT

Tumor board discussion absent for locally advanced disease

SBRT / SABR IMRT Concurrent ChemoRT 3D-CRT Oligomet SBRT

🦴

Bone Mets / Palliative

4 metastatic sites · SRS, spine SBRT & conventional palliation

Top denial triggers

Spine SBRT: SINS score & Bilsky classification absent — the two critical payer gates

SRS: lesion count and diameter not documented (most payers limit to ≤4 lesions)

Oligomets: total systemic lesion count missing from documentation

Performance status (ECOG / KPS) absent — required for all palliative authorizations

Spine SBRT SRS (Single Fx) Hypofrax SRS Conventional Palliation Liver / Adrenal SBRT

What's Built In

Built for how radiation oncology
prior authorization actually works

Every feature was designed around the specific documentation patterns that drive rad onc technique denials — not generic PA logic borrowed from other specialties.

🎯

Site × Technique Criteria Matrix

Each site/technique combination loads its own criteria checklist. Prostate SBRT checks prostate volume, IPSS, TURP history. Breast APBI runs all 8 ASTRO suitability criteria. Spine SBRT requires SINS score and Bilsky grading. Not generic — surgical-specialty specific.

🏦

7 Montana Payer Policies Built In

BCBS Montana/Premera, PacificSource/AIM, Medicare Noridian J15, UHC, Cigna, Montana Medicaid, and Allegiance TPA. Each payer's specific documentation requirements, not generic commercial standards. Noridian J15 LCDs are structurally different from WPS — that matters.

📋

NCCN Guideline Integration

Payers cite NCCN category recommendations directly in technical denial letters. White Rabbit checks that your documentation aligns with the applicable NCCN category — and flags when it doesn't — so the reviewer's checklist can't find a gap before you do.

🚨

Critical Item Flagging

Not all missing criteria are equal. SINS score for spine SBRT, ASTRO criteria for APBI, PFT for lung SBRT — these are hard gates that will trigger an immediate denial regardless of everything else. White Rabbit surfaces critical items with a distinct flag so your PA team knows what must be addressed first.

✍️

Physician-Authored Addendum

After gap analysis, generate a clinical addendum in attending-physician language that addresses every missing or unclear criterion — with NCCN citations and bracketed placeholders for values only the physician can supply (dosimetric data, specific lab values, exam findings).

🔄

Always Current Criteria

Payer policies in radiation oncology change frequently — new LCD revisions, AIM criteria updates, NCCN guideline releases. Subscribers always receive the latest criteria automatically. No downloads, no version management. When Noridian revises the SBRT LCD, the tool updates.

Payers Covered

The payers your Montana patients carry

All major commercial and government payers in Montana, with the specific criteria source and known quirks for each. Noridian J15 is your Medicare contractor — not WPS — which means different LCDs than neighboring states.

Payer

Criteria Source

Key Notes

BCBS Montana

Premera affiliate

Premera clinical policy bulletins

Conservative

Requires dosimetric comparison for IMRT vs 3D-CRT and technique upgrade justification. NCCN category citation in letter of medical necessity.

PacificSource

MT / ID / OR regional

AIM Specialty Health

AIM Review

AIM criteria are publicly available and highly site-specific. Physician attestation of eligibility recommended in submission letter.

Medicare (Noridian J15)

Covers MT, ID, WY, ND, SD

Noridian LCDs (SBRT, IMRT, Proton)

LCD-Based

Separate LCDs for SBRT (L37558), IMRT, and proton. Medical necessity narrative must go beyond protocol compliance.

UnitedHealthcare

National commercial

Optum + AIM Specialty Health

AIM Review

Follows NCCN Category 1 as baseline. Proton authorization is the strictest fight — dosimetric comparison and UHC proton policy criteria required.

Cigna

National commercial

Cigna oncology coverage policies

NCCN Aligned

Most predictable commercial payer when documentation is complete. NCCN Category 1 aligned. Clinical indication for IMRT over 3D-CRT required.

Montana Medicaid

DPHHS policies

Montana DPHHS criteria

Most Restrictive

Conventional fractionation is the default. Advanced techniques require documented justification for why conventional is insufficient or contraindicated.

Allegiance Benefit Plan

TPA · employer-plan specific

Plan-by-plan (standard commercial baseline)

TPA Variable

Criteria vary by employer plan. Tool applies standard commercial baseline. Allegiance may subcontract review to AIM or Carelon.

Pricing

Simple flat monthly pricing

One denied SBRT course covers a year of White Rabbit. Most practices recover the annual cost in the first week.

Single Physician

$547 /mo

per radiation oncologist

✓ All 4 cancer sites and 20+ site/technique combos
✓ All 7 Montana payers
✓ Denial risk scoring on every case
✓ AI clinical addendum generator
✓ NCCN guideline alignment checks
✓ Unlimited analyses
✓ Criteria updates included

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Prior Auth Shouldn'tDelay Cancer Treatment

Prior Auth Shouldn't
Delay Cancer Treatment