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Wellcare / New Century Health PA Requirements Effective October 1, 2023

Wellcare has partnered with New Century Health (NCH) to implement a new cardiology prior authorization program called the Cardiology Management Program. This program is intended to help providers easily and effectively deliver quality patient care.

Effective Oct. 1, 2023, cardiology services rendered in a physician’s office, in an outpatient hospital ambulatory setting, or in an inpatient setting (planned professional services only) must be submitted to NCH for prior authorization. Approvals issued by Wellcare before Oct. 1, 2023, are effective until the authorization end date, but all prior authorization requests needed after Oct. 1, 2023, must be submitted to NCH. This requirement applies to all of your Medicare members ages 18 and older.

Prior authorization can be requested by:

  • Visiting NCH’s web portal at my.newcenturyhealth.com.
  • Calling 1-888-999-7713, Option 1 Monday through Friday, from 5 a.m. to 5 p.m., Pacific time.

NCH uses clinical criteria based on nationally recognized guidelines to promote evidence-based guidelines. When using NCH’s web portal, you will be able to:

  • Obtain real-time approvals when selecting evidence-based NCH treatment care pathways.
  • Determine what clinical documentation is needed for medical necessity review.
  • View all submitted requests in one location.
  • Request to speak with a cardiologist to discuss treatment options.

Wellcare has also partnered with NCH to implement a new oncology prior authorization program called Oncology Pathway Solutions.

Effective Oct. 1, 2023, oncology-related chemotherapeutic drugs, including supportive agents and radiation oncology treatments, will require prior authorization from NCH before being dispensed at a pharmacy or administered in a physician’s office, outpatient hospital, or ambulatory setting. Approvals issued by Wellcare before Oct. 1, 2023, are effective until the authorization end date, unless there is a change in treatment, at which point you must submit a new request for authorization through NCH. All prior authorization requests needed after Oct. 1, 2023, must be submitted to NCH. This requirement applies to all of your Medicare members ages 18 and older.

Prior authorization can be requested by:

  • Visiting NCH’s web portal at my.newcenturyhealth.com.
  • Calling 1-888-999-7713, Option 2 for medical oncology, Option 3 for radiation oncology
  • Monday through Friday, from 5 a.m. to 5 p.m., Pacific time.

NCH uses clinical criteria based on nationally recognized guidelines to promote evidence-based cancer care. When using NCH’s web portal, you will be able to:

  • Obtain real-time approvals when selecting evidence-based NCH treatment care pathways.
  • Determine what clinical documentation is needed for medical necessity review.
  • View all submitted requests in one location.
  • Request to speak with an oncologist to discuss treatment options.

Wellcare is proud to be your healthcare partner. If you frequently prescribe cardiology services and/or oncology medications and are new to this process, an NCH representative will contact you soon to schedule an introductory meeting and training. If you are new to NCH, portal login credentials will be securely emailed to you after your meeting but before Oct. 1, 2023.

If you need access to NCH’s portal and have not received a call from NCH, or if you have any questions beforehand, please email providertraining@newcenturyhealth.com or call NCH at 1-888-999-7713, Option 6. You may also call Wellcare directly at 1-855-538-0454 or visit wellcare.com. Just choose your state from the drop-down menu and click on “Providers.”

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Last Updated On: 9/22/2023
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