Fall 2020
As of 9/1/2020, Neighborhood will be utilizing New Century Health (NCH), an oncology quality management company, to simplify the administrative process for providers and support the effective delivery of quality patient care. The benefits of partnering with NCH include:
- The use of clinical criteria based on nationally-recognized guidelines, to promote evidence-based cancer care,
- Physician discussions with medical oncologists or radiation oncologists, and
- A provider web portal that allows providers to:
- Obtain real-time approvals when selecting evidence-based NCH treatment care,
- Determine which clinical documentation is needed for medical necessity review,
- View all submitted requests for authorization in one location, and
- Check member eligibility.
Scope
The following will require a prior authorization from NCH before administration of the drug or treatment in the provider’s office, outpatient hospital, ambulatory setting, or infusion center:
- Oncology-related chemotherapeutic drugs and supportive agents,
- Hematology-related drugs and supportive agents,
- Radiation oncology treatment, and
- Genomic/genetic testing for oncology-related chemotherapy treatment
Medical specialties included in this program are Medical Oncology and Hematology, Pediatric Oncology and Hematology, Gynecologic Oncology, Urology, Surgical Oncology* (*medications only), and Radiation Oncology. Beginning September 1, 2020, these provider specialties will submit their chemotherapy/hematology drug, radiation treatment, and genomic/genetic testing requests for prior authorization through NCH.
This prior authorization requirement applies to all Neighborhood members in all lines of business, Medicaid, Commercial, and INTEGRITY (Medicare-Medicaid Plan).
How to Submit a Request
The requesting physician must complete an authorization request using one of the following methods:
- Log into the NCH provider portal: https://my.newcenturyhealth.com
- Call NCH at 1-888-999-7713, Monday–Friday 8:00 a.m. to 8:00 p.m. EST
- Medical Oncology and Genomic/Genetic Testing – Option 1
- Radiation Oncology – Option 2
With the NCH program, there are no changes to your current claims submission process.
Authorizations
Authorizations issued by Neighborhood before September 1, 2020 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/treatments that did not require an authorization prior to September 1, 2020, an authorization will be required from NCH for service/treatment dates on and after September 1, 2020.
New Century Health Oncology/Hematology Resources
Prior Authorization Criteria can be found on the Pharmacy Provider Resources Webpage by going through the following links:
www.nhpri.org > Providers > Provider Resources > Pharmacy > Criteria > Oncology/Hematology Medicaid Prior Authorization Criteria
OR
For Medical Pharmacy Benefit Oncology/Hematology medication policies, please visit the Pharmacy Provider Resources Webpage by going through the following links:
www.nhpri.org > Providers > Provider Resources > Pharmacy > Clinical Medical Policies > Oncology/Hematology Medicaid Prior Authorization Criteria
OR
Directly at https://www.nhpri.org/providers/policies-and-guidelines/clinical-medical-policies/