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Introducing New Century Health - Oncology Pathway Solutions

Date: 04/07/21

Sunflower Health Plan is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company. New Century Health will be responsible for oncology prior authorizations. This program will simplify the administrative process for providers to support the effective delivery of quality care for patients with cancer.

Beginning May 10, 2021, all oncology-related infused and oral chemotherapeutic drugs/supportive agents listed on the KDHE Prior Authorization Criteria for Oncology Agents and Oncology – Auxiliary Treatment Agents will require a prior authorization from NCH before being administered in either the provider’s office, outpatient hospital, ambulatory setting or infusion center. Authorizations for Medicaid members ages 21 and over will be reviewed by NCH.

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 a true peer, medical oncologists who can understand and better 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

Prior Authorization Process:

The requesting physician must complete an authorization request using one of the following methods:

  • Online Portal: Log in to the NCH Provider Web Portal
  • Phone: 1-888-999-7713, Medical Oncology - Option 1, Monday–Friday 7 AM to 7 PM CT

Transition of Care:

Authorizations issued by Sunflower Health Plan before May 10, 2021, 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 May 10, 2021, an authorization will be required from New Century Health for service/treatment dates on and after May 10, 2021.

Frequently Asked Questions

See answers to frequent questions.