New Oncology and Radiation Prior Authorization Program Effective Aug. 2, 2021

Fecha: 29/06/21

Ambetter from Sunshine Health is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company, to implement a new Oncology Pathway Solutions Program. The program will simplify the administrative process for providers to support the effective delivery of quality patient care.

Beginning Aug. 2, 2021, all radiation treatments for members of all ages will require a prior authorization from NCH before being administered in either the provider’s office, outpatient hospital, ambulatory setting or infusion center. Medical oncology-related infused, oral chemotherapeutic drugs/supportive agents will continue to require prior authorization for adults. Beginning Aug. 2, 2021, a prior authorization will be required for medical-oncology services for members of all ages.

Benefits include:

• The 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
• A provider web portal to: 
  • Obtain real-time approvals when selecting evidence-based NCH treatment care pathways.
  • Determine which clinical documentation is needed for medical necessity review.
  • View all submitted requests for authorization in one location.
  • Check member eligibility.

Providers must complete an authorization request using one of the following methods:

• Logging into the NCH Provider Web Portal
• Calling 1-888-999-7713, Monday–Friday 8 a.m. to 8 p.m. Eastern

Medical Oncology - Option 1, Radiation Oncology - Option 2

Transition of Care:

Authorizations issued by Ambetter from Sunshine Health before Aug. 2, 2021 will be effective until the authorization expiration date. To obtain a new valid authorization on or after Aug. 2, 2021, providers must submit the request to New Century Health.

A New Century Health representative will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please call Ambetter from Sunshine Health at 1-877-687-1169. You may also contact NCH at 1-888-999-7713, Option 6.

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