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Attention Oncology Providers: Fidelis Care Partners with New Century Health for New York Medicaid, Essential Plan, and Qualified Health Plan Members
9/2/2020 • Posted by Provider Relations

Fidelis Care is pleased to announce we have partnered with New Century Health (NCH) to implement a new oncology prior authorization program, Oncology Pathway Solutions. The program will make it easier for providers to effectively deliver quality patient care. 

 

Effective November 2, all oncology-related chemotherapeutic medications and supportive agents will require prior authorization from NCH before being dispensed at a pharmacy or administered in a physician’s office, outpatient hospital, or ambulatory setting. This requirement applies for Medicaid Managed Care, Essential Plan, and Qualified Health Plan members, ages 18 and older.


Prior authorization can be requested by:

·         Visiting NCH’s Web portal at my.newcenturyhealth.com, or

·         Calling 1-888-999-7713, option 1 (Monday-Friday, 8AM-8PM)

 

NCH uses clinical criteria based on nationally recognized guidelines to promote evidence-based cancer care.When using the Web portal, you can obtain real-time approvals when selecting evidence-based NCH treatment care pathways. You will also be able to determine which clinical documentation is needed for medical necessity review, and view all submitted requests in one location. You may also request to speak with an oncologist to discuss treatment options.

Fidelis Care is proud to be your health care partner. An NCH representative will contact you soon to schedule an introductory meeting and training. Portal login credentials will be securely emailed to you after your meeting and before November 2. If you have any questions beforehand, you may call NCH at 1-888-999-7713, Option 6. You may also call us at 1-888-FIDELIS (1-888-343-3547; TTY: 711) or visit our frequently asked questions. We are here to help.

Authorization Resources

To submit prior authorization request types, use the Fidelis Care provider portal.

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Important Information on Coverage Decisions

Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on many health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward providers or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff based on decisions that promote underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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