New Century Health (NCH) is a comprehensive quality management company that EmblemHealth has designated as its newest utilization review agent. NCH offers collaboration and peer-to-peer discussions with oncologists’ and physicians’ offices. They have a provider web portal where you can request preauthorizations, select treatment care pathways, obtain help with documentation, and more.
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Frequently Asked Questions: EmblemHealth Oncology Drug Management
As of Jan. 1, 2021, NCH handles utilization management for most oncology-related chemotherapeutic drugs and supportive agents when delivered in the physician’s office, outpatient hospital, or other ambulatory setting. NCH emphasizes and supports the selection of Preferred Pathways for adult oncology patient care.
Medical specialties providing cancer care and its supportive services, including medical oncology, hematology, urology, and gynecologic oncology.
Yes, NCH will not manage most EmblemHealth Plan, Inc. (formerly GHI) members, members managed by HealthCare Partners and Montefiore CMO, or any members under 18 years of age.
The following services are excluded from the program:
- Requests for patients under 18 years of age
- Equipment requests (e.g., IV pump)
- Inpatient requests
- Hemophilia drugs
- Bone marrow transplants
- Inpatient chemotherapy services
- ESRD patients
- Clinical trials
- Radiopharmaceuticals
- All places of treatment and services not specifically listed above
Register at my.newcenturyhealth.com.
Request training on the provider portal. You may also contact NCH Network Operations at 888‑999‑7713, option 6, 8 a.m. to 8 p.m., Monday to Friday.
Preauthorization
NCH’s provider portal is always available, offering:
· Real-time authorizations for oncology treatment care pathways.
· Reduced documentation requirements.
· View of real-time status of preauthorization requests.
· Eligibility verification.
· Supportive telephonic authorization staff available at 888-999-7713, 8 a.m. to 8 p.m., Monday to Friday.
· Quick turnaround time on preauthorization requests submitted via portal, fax, or phone.
· Peer-to-peer consultations by medical oncologists.
· An NCH provider representative is available for support as needed.
· You can also fax preauthorization request forms to 877-624-8602.
All preauthorizations issued by EmblemHealth before Jan. 1, 2021 will remain valid until they expire.
If the request does not meet evidence-based treatment guidelines, NCH may request additional information or initiate a peer-to-peer conversation with the requesting provider. NCH medical reviewers are licensed medical oncologists and use nationally recognized clinical guidelines when performing reviews.
These guidelines are available at my.newcenturyhealth.com or by contacting NCH’s Utilization Management at 888-999-7713, option 6, 8 a.m. to 8 p.m., Monday to Friday.
Claims
EmblemHealth is responsible for grievance and appeals. Providers can initiate a grievance or appeal with EmblemHealth by mail or fax:
Line of Business |
Fax # |
Mailing Address |
|---|---|---|
Medicare |
Standard – 866-854-2763 Expedited – 866-350-2168 |
PO Box 2844 New York, NY 10116 |
Medicaid |
Standard – 212-510-5320 Expedited – 866-350-2168 |
|
Commercial |
For more information on grievance and appeals processes for the above plans, see the following chapters in the EmblemHealth Provider Manual:
Dispute Resolution for Commercial and CHP Plans
Dispute Resolution for Medicaid Managed Care Plans
Dispute Resolution for Medicare Plans
