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New Century Health Partnership and Prior Authorization Changes

August 29, 2023

WellCare of Kentucky is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company, to implement a new prior authorization program.

The program will simplify the administrative process for providers to support the effective delivery of quality patient care.

Beginning October 1, 2023, oncology-related infused chemotherapeutic drugs/supportive agents/symptom management medications, and radiation oncology will require a prior authorization from NCH before being administered in either the provider’s office, outpatient hospital, ambulatory setting, or infusion center. Treatment plans will be reviewed using nationally recognized evidence-based guidelines.

Pharmacy benefit medications that are part of an infused regimen are required to be submitted to NCH to allow NCH to review as an entire regimen to make a clinically informed decision. The pharmacy benefit portion of the regimen may require prior authorization from MedImpact for the medication(s) to be dispensed. Please visit kyportal.medimpact.com for more information.

This prior authorization requirement applies to your WellCare of Kentucky (Medicaid) members of all ages.

We hope you will find value in the following changes coming with the NCH partnership:

  • Real-time authorizations issued for approvable treatment plans submitted via the NCH online portal https://my.newcenturyhealth.com
  • Ability to confirm member eligibility through the NCH portal prior to entering a treatment plan
  • Oncologists on staff to answer your questions
  • Telephonic Intake available for submitting treatment plans, if needed
  • Dedicated NCH Provider Network Manager to use as a direct point-of-contact for any issues or questions

Authorizations issued by WellCare of Kentucky prior to October 1, 2023 are effective until the authorization end date. Upon expiration, authorization requests must be submitted to NCH. If continued authorization is not obtained from NCH, affected claims may be denied. For services/treatment that did not require an authorization prior to October 1, 2023, an authorization will be required from New Century Health for service/treatment dates on and after October 1, 2023.

A Provider Solutions Manager will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please contact NCH at 1-888-999-7713, Option 6 or send an email to providertraining@newcenturyhealth.com.

We look forward to offering you this program and hope that it will enhance your experience with your oncology service authorizations.

Sincerely,

WellCare of Kentucky

Frequently Asked Questions - FAQs

Q1: Who is New Century Health?

A1: New Century Health (NCH) is a comprehensive oncology quality management (OQM) company. Its platform optimizes the application of evidence-based medicine in the delivery of adult ambulatory cancer care.

Q2: What is the WellCare Kentucky Oncology Pathway Solutions program?

A2: WellCare Kentucky Oncology Pathway Solutions program provides prior authorization management for all infusible, injectable chemotherapy agents, supportive drugs/symptom management drugs and radiation oncology. The program emphasizes and supports the selection of Preferred Pathways for patient care and is administered by New Century Health.

Pharmacy benefit medications that are part of an infused regimen are required to be submitted to NCH to allow NCH to review as an entire regimen to make a clinically informed decision. The pharmacy benefit portion of the regimen may require prior authorization from MedImpact for the medication(s) to be dispensed. Please visit kyportal.medimpact.com for more information.

Q3: Is this for all WellCare of Kentucky members?

A3: The WellCare of Kentucky Oncology Pathway Solutions program pertains to your Medicaid members of all ages.

Precertification, preauthorization and notification requirements all refer to the same process of prior authorization.

Q4: When will the WellCare of Kentucky Oncology Pathway Solutions program begin?

A4: The program will begin October 1, 2023.

Q5: How can a physician’s office request training for this program?

A5: A Provider Solution Manager will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please contact NCH at 888-999-7713, Option 6, or send an email to providertraining@newcenturyhealth.com.

Q6: What are some key features of the program?

A6: The online provider portal is always available, offering the following:

  • Real-time authorizations for treatment care pathways
  • Reduced documentation requirements
  • View of real-time status of authorization requests
  • Eligibility verification

Supportive telephonic authorization staff available at 1-888-999-7713,

  • Medical Oncology - Option 2
  •  Radiation Oncology - Option 3
    • Monday - Friday, 5:00 AM - 5:00 PM PST (Fully Staffed)
    • Saturday, 5:00 AM - 6:00 PM PST (Limited Staff) *
    • Sunday, 6:00 AM - 3:00 PM PST (Limited Staff) *
    • *After hours call coverage available from Monday - Friday 6PM - 5AM PST
  • Quick turnaround time on authorization requests submitted via portal or phone
  • Physician Discussions with medical oncologists or radiation oncologists
  • New Century Health is a National Comprehensive Cancer Network (NCCN) licensee of the Drugs and Biologics Compendia. It uses nationally recognized, evidence-based treatment guidelines
  • New Century Health provider representatives are available for support as needed.

Q7: What is the transition of care process?

A7: Authorizations previously issued by WellCare of Kentucky before October 1, 2023, will be effective until the authorization expiration date. Requests for new treatment and/or changes in treatment on or after October 1, 2023, must be submitted to New Century Health for preauthorization.

Q8: Who should obtain prior authorization?

A8: The physician organization ordering chemotherapeutic drugs or supporting agents for the treatment of cancer or related hematologic diseases must request prior authorization through New Century Health.

Q9: How do I obtain prior authorization?

A9:  Submit chemotherapy requests to New Century Health via the following methods:

  • Log into New Century Health’s provider web portal at my.newcenturyhealth.com
  •  Contact New Century Health’s Utilization Management Intake Department at 1-888-999-7713
    • Medical Oncology - Option 2
    • Radiation Oncology - Option 3
      • Monday through Friday (5 AM-5 PM PST)

Q10: Which drugs require prior authorization?

A10: WellCare of Kentucky Oncology Pathway Solutions Program, administered by New Century Health, requires prior authorization management for chemotherapeutic drugs, symptom management drugs and supporting agents for members with a diagnosis code included in the following range:

Cancer = C00 – D09, D37-D44, E34.0
Hematology Diagnosis = 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
N&V = R11

Q11: Which specialties are included in the WellCare of Kentucky Oncology Pathway Solutions program?

A11: Medical specialties providing cancer care and its supportive services including Medical Oncology, Hematology, Urology, Surgical Oncology, Neurological Oncology, Gynecologic Oncology, Radiation Oncology, and Pediatric Oncology (Medicaid only) will submit their chemotherapy and radiation oncology prior authorizations through New Century Health.

Q12: Who at New Century Health will be reviewing chemotherapy requests?

A12: New Century Health Medical Reviewers are licensed medical oncologists and radiation oncologists and are not incentivized to issue denials, as they use nationally recognized clinical guidelines when performing reviews. These guidelines are available at  my.newcenturyhealth.com or by contacting New Century Health's Utilization Management at 1-888-999-7713.

If the request does not meet evidence-based treatment guidelines, New Century Health may request additional information or initiate a peer-to-peer conversation with the requesting provider.

Q13: What will the New Century Health authorization look like, and how long is it valid?

A13: The NCH authorization will start with "AR" followed by at least four digits (e.g., AR1000). It is valid for the duration indicated on the Medication Request Authorization (MRA).

* Please submit claims to WellCare of Kentucky using the prior authorization number provided in the letter from WellCare Kentucky, not the NCH authorization number. The WellCare of Kentucky authorization number will begin with "OP" followed by 10 digits.

Q14: What place of service does this prior authorization review process include?

A14: The Oncology Pathway Solutions program applies to services rendered (e.g., chemotherapy administration) in an outpatient setting, which could include the physician’s office, infusion centers and outpatient hospital locations.

Q15: Does a prior authorization guarantee payment?

A15: No, a prior authorization does not guarantee payment for services. Payment of claims is dependent on eligibility, covered benefits, provider contracts, and correct coding and billing practices. For specific details, please refer to your Provider Manual.

Q16: What will happen if the physician does not request and obtain an authorization?

A16: If a required authorization is not obtained, WellCare of Kentucky may deny payment for the relevant drugs. Members cannot be held responsible or billed for denied charges/services. Providers may only collect the applicable cost share amount directly from the member.