New Century Health (NCH)
Sunshine Health Oncology Pathway Solutions is an oncology pre-approval program supported by New Century Health (NCH), an oncology quality management company. The program assists Sunshine Health providers to effectively deliver quality patient care and make the administrative process faster and easier.
All oncology-related chemotherapeutic drugs and supportive agents require a preauthorization from NCH before being administered in a physician’s office, outpatient hospital or ambulatory setting. This prior authorization applies to all oncology drugs for Ambetter members over the age of 18. For Medicaid, the prior authorization applies to members over the age of 18, only if the oncology drug is noted as requiring prior authorization on the Agency for Health Care Administration’s pharmacy drug list (PDL).
Benefits of the program 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.
- Peer-to-peer discussions with 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 necessary for medical necessity review.
- View all submitted requests for authorization in one location.
- Check member eligibility.
Providers must complete an authorization request using one of the following methods:
- Logging in to the NCH Provider Web Portal
- Calling 1-877-624-8601 (Monday– Friday 8 a.m.-8 p.m. ET)
- Faxing the authorization form to 1-877-624-8602