New Century Health - Oncology Pathway Solutions
Buckeye Health Plan is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company, to implement a new oncology pre-approval program, Buckeye Health Plan Oncology Pathway Solutions. The program will simplify the administrative process for providers to support the effective delivery of quality patient care.
Beginning September 3, 2019, all oncology-related chemotherapeutic drugs and supportive agents will require clinical review by NCH before being administered in a physician’s office, outpatient hospital or ambulatory setting. This prior authorization requirement applies to both pharmacy dispensed and office administered medication requests for all Buckeye Health Plan Medicaid members ages 18 and over.
Buckeye Health Plan Oncology Pathway Solutions program benefits include:
- The use of clinical criteria, based on nationally-recognized guidelines, to promote evidencebased cancer care.
- Increased collaboration with physician offices to foster a team approach.
- Peer-to-peer discussions with medical oncologists who can understand and better discuss treatment plans.
- A provider web portal https://my.newcenturyhealth.com to:
- Obtain real-time approvals when selecting evidence-based NCH treatment care pathways.
- Determine which clinical documentation is necessary for medical necessity review.
- View all submitted requests for authorization in one location.
- Check member eligibility.
- The requesting physician must complete an authorization request using one of the following methods:
- Logging into the NCH Provider Web Portal: https://my.newcenturyhealth.com
- Calling 1-888-999-7713, Option 1, Monday–Friday (8 a.m. - 8 p.m. ET)
Timeframe for Approval
Real-time approval is given for NCH recommended treatments. Timeframes for authorization of treatment regimens not auto approved by NCH are as follows: Medicaid requests:
- Pharmacy: 24 hours
- Office Administered: 48 hours for expedited requests and 10 days for standard requests
NCH may approve chemotherapeutic and supporting agents, including hematology drugs, for a period up to 90 days.
Authorizations issued by Buckeye Health Plan or Envolve Pharmacy Solutions before September 3, 2019 are effective until the authorization end date. Subsequent authorization requests must be submitted to NCH. If continued authorization is not obtained from NCH, drug-related claims may be denied.
- Inpatient requests for chemotherapy should continue to be submitted via Buckeye’s Secure Provider Portal at www.buckeyehealthplan.com/providers.html
- Inpatient requests for chemotherapy may also be submitted via Buckeye’s Secure Fax at 1-866-529-0291
- Pharmacy dispensed chemotherapeutic and supportive agents that were previously submitted to
Envolve Pharmacy Solutions or CoverMyMeds, should be submitted directly to NCH
- Failure to obtain prior authorization may result in denial of payment.
An NCH representative will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please call NCH at 1-888-999-7713, Option 6. You may also contact Buckeye Health Plan at 1-866-296-8731.
Please see below for find a list of medications that will need prior authorization for the medical benefit starting 9/3/19. There will be no changes to the pharmacy benefit. For pharmacy benefit questions, please refer to Buckeye Health Plan’s preferred drug list at https://www.buckeyehealthplan.com/providers/pharmacy.html.
Please note any request using a generic J code (examples: J3490, J8499, J9999) will need a single case agreement to ensure proper payment. We look forward to offering you this program and hope that it will enhance your experience with oncology service authorizations.