New Century Health Oncology Treatment Notice and FAQ
Date: 09/29/23
Dear Providers and Staff,
Arizona Complete Health (Medicaid, Medicare, and Marketplace) and Care1st (Medicaid) are partnering with New Century Health (NCH), to implement NCH’s radiation oncology prior authorization program. You may already work with NCH to obtain authorization for your Medicaid, Medicare and Marketplace members needing oncology-related infused and oral chemotherapeutic drugs/supportive agents being administered in either the provider’s office, outpatient hospital, ambulatory setting, or infusion center.
Places of Service and Members Included in this Program
Effective November 1, 2023, radiation oncology treatments provided in ambulatory, outpatient hospital, provider office settings require a prior authorization from NCH before being administered. The change applies to Medicaid and Marketplace members of all ages and Medicare members 18 years and older.
Inpatient authorization for radiation oncology treatments will continue to be submitted to Arizona Complete Health or Care1st. Please refer to the Pre-Auth Check Tool to identify PA requirements.
NCH Prior Authorization Process
The requesting physician completes an authorization request using one of the following methods:
▪ Logs into NCH’s Provider Web Portal my.newcenturyhealth.com
▪ Calls 888-999-7713 (Mon – Fri 6:00 AM – 6:00 PM PST):
- Medical Oncology – Option 2
- Radiation Oncology – Option 3
NCH Approval Timeframes
Real-time approval is given for NCH recommended treatments. The table below outlines timeframes for authorization of treatment regimens not recommended by NCH:
| Line of Business | Type of Request | Type of Request | Approval |
|---|---|---|---|
| Standard | Expidited | ||
| All | 7 Calendar Days | 36 Hours | NCH may approve radiation oncology requests for a period up to 90 days |
NCH may approve radiation oncology requests for a period up to 90 days
Radiation Oncology Authorizations Issued Prior to November 1, 2023
Authorizations issued prior to November 1, remain in effect until the authorization expiration date unless there is a change in treatment, at which point a new authorization through NCH is required. Additionally, any CPT/HCPCS codes within NCH’s review scope, which did not previously require prior authorization will require prior authorization for dates of service November 1, 2023, and after.
For additional information please reference the Frequently Asked Questions document included with this communication.
Benefits of Working with NCH
▪ Use of clinical criteria, based on nationally recognized guidelines, to promote evidence-based cancer care
▪ Increased collaboration with physician offices to foster a team approach
▪ Physician discussions with medical oncologists or radiation oncologists who can understand and discuss treatment plans
• Ph. 888-999-7713
- Medical Oncology - Option 2, 6
- Radiation Oncology - Option 3, 5
▪ A web-based provider portal that offers:
• Check member eligibility
• View and manage all submitted requests for authorization in one location
• Obtain real-time auto-approvals when selecting evidence-based NCH’s treatment pathways
• Ability to upload supporting clinical documentation that is needed for medical necessity review
An NCH representative will soon contact you to discuss this update. If you are not currently registered to use NCH’s portal, portal login credentials will be securely emailed to you after your meeting and before November 1. If you have questions prior to the meeting, please call NCH at 1-888-999-7713, Option 6 for assistance.
Thank you for working with us as we implement this program. We hope it will enhance your experience with radiation oncology authorizations.