Skip to Main Content

New Century Health Oncology Expansion

Date: 05/02/22

Dear Oncology Providers and Office Staff:

We have been working with New Century Health (NCH) for review of oncology-related chemotherapeutic drugs and supportive agents for adult Medicaid (AZ Complete Health-Complete Care Plan) and Marketplace (Ambetter) members since July 1, 2019.

Effective July 1, 2022, we will use the oncology pre-approval program, Arizona Complete Health’s Oncology Pathway Solutions, for all Medicaid and Marketplace members including pediatric members.  We also are updating the diagnosis set (refer to the FAQ).

Oncology-related chemotherapeutic drugs and supportive agents will require pre-authorization from NCH before being dispensed at a pharmacy or administered in a physician’s office, outpatient hospital or ambulatory setting. This requirement applies for your Medicaid and Ambetter members of all ages.

Prior authorization can be requested from NCH by:

  • Visiting NCH’s Web Portal: my.newcenturyhealth.com
  • Calling 1-888-999-7713, Option 1 (Monday – Friday 8AM to 8PM)

NCH uses clinical criteria based on nationally recognized guidelines to promote evidence-based cancer care.  When using the Web Portal, you can obtain real-time approvals when selecting evidence-based NCH treatment care pathways.  You can also determine which clinical documentation is needed for medical necessity review, and view all submitted requests in one location.  You may also request to speak with an oncologist to discuss treatment options.

Timeframe for Approval

Real-time approval is given for NCH recommended treatments. Timeframes for authorization of treatment regimens not recommended by NCH are as follows:

  • Medicaid Pharmacy or Office Administered: 24 hours or 7 business days if more information is requested
  • Ambetter Pharmacy: 24 hours urgent, 72 hours standard
  • Ambetter Office Administered: 72 hours urgent, 14 calendar days standard

NCH may approve chemotherapeutic and supporting agents, including hematology drugs, for a period up to 90 days.

Medicaid and Marketplace prior authorizations issued by Arizona Complete Health before July 1, 2022, are effective until the authorization end date. Subsequent prior authorization requests must be submitted to NCH. If continued authorization is not obtained from NCH, drug-related claims may be denied.

An NCH representative will contact you soon to discuss this update. If you are not currently registered to use the NCH portal, portal login credentials will be securely emailed to you after your meeting and before July 1. If you have any questions beforehand, please call NCH at 1-888-999-7713, Option 6 and allow them to help.

Sincerely,

Scott W. Van Valkenburg, MD

Chief Medical Director Arizona Complete Health