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New Century Health

About New Century Health - Oncology Pathway Solutions

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 (FAQs)

General Information

New Century Health (NCH) is a comprehensive oncology quality management (OQM) company. Its platform optimizes the application of evidence-based medicine in the delivery of adult ambulatory cancer care.

Sunflower Health Plan Oncology Pathway Solutions program includes prior authorization management for all drugs listed on the KDHE Prior Authorization Criteria for Oncology Agents (PDF) and Oncology – Auxiliary Treatment Agents (PDF).

The Sunflower Health Plan Oncology Pathway Solutions program is for Sunflower Health Plan Medicaid members 21 years old and older. The new review process applies to services for these members. Pediatric members (<21 years of age) will be reviewed outside of this program by Sunflower Health Plan. 

The program will begin May 10, 2021, for Sunflower Health Plan members 21 years of age and older.

To request training, contact NCH Network Operations at 1-888-999-7713, Option 6.

Prior Authorization

Key features are:

  • The online provider portal is available 24/7 offering:
    • Real-time authorizations for treatment care pathways
    • Reduced documentation requirements
    • View of real-time status of authorization requests
    • Eligibility verification
  • Supportive telephonic authorization staff available by dialing 1-888-999-7713, Option 1, Monday–Friday (7 a.m. - 7 p.m. CT)
  • Quick turnaround time on authorization requests submitted via fax or phone
  • Physician discussion requests by medical oncologists
  • NCH is a National Comprehensive Cancer Network (NCCN) licensee of the Drugs and Biologics Compendia. It uses nationally recognized, evidence-based treatment guidelines
  • An NCH provider representative is available for support as needed

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.

The physician organization ordering chemotherapeutic drugs or supporting agents for the treatment of cancer or related hematologic diseases must request preauthorization through NCH.

Submit chemotherapy requests to New Century Health via the following:

  • PREFERRED:  Log into NCH’s provider web portal at https://my.newcenturyhealth.com
  • Contact NCH’s Utilization Management Intake Department at 1-888-999-7713
    (Monday through Friday, 7 a.m. – 7 p.m. CT)

Medical specialties providing cancer care and its supportive services, including Medical Oncology, Hematology, Urology, Surgical Oncology, Neurological Oncology and Gynecologic Oncology will submit their chemotherapy pre-authorizations through NCH.

If the request does not meet evidence-based treatment guidelines, NCH may request additional information or initiate a consultation request with the ordering provider. NCH Medical Reviewers are licensed medical oncologists that use nationally recognized clinical* guidelines when performing reviews and are not incentivized to issue denials.

*Guidelines are available by contacting NCH’s Utilization Management at 1-888-999-7713, Option 1.

NCH will send an initial authorization identifier that will start with “AR” followed by at least four digits (i.e. AR1000). Sunflower will issue an authorization number that will begin with “OP” followed by 10 digits. Please bill with the Sunflower Health Plan prior authorization number provided by the health plan. 

The Oncology Pathway Solutions program applies to services rendered (e.g. chemotherapy administration) in an outpatient setting, which could include the physician’s office, infusion centers or outpatient hospital locations.

Claims

Submit claims to Sunflower Health Plan either electronically or by mail to the following address:

Sunflower Health Plan
P.O. Box 4070
Farmington, MO 63640-3833

The payer ID for electronic claim filing is 68069. Please refer to the back of the member’s ID card for specific instructions.

No, a prior authorization does not guarantee payment for services. Payment of claims is dependent on eligibility, covered benefits, provider contracts and correct coding and billing practices. For specific details, please refer to your Provider Manual.

If authorization is not obtained for the applicable drugs, Sunflower Health Plan may deny payment for respective drugs. Members cannot be held responsible for denied charges/services.