Evolent/NCH Oncology Pathway Solutions / Cardiology Management Program

Date: 09/26/24

Wellcare has partnered with Evolent (formerly New Century Health, NCH) to implement a new oncology prior authorization program, Oncology Pathway Solutions. Effective December 1, 2024, Evolent/NCH will manage prior authorization requests for Medical Oncology and Radiation Oncology treatments provided in an outpatient setting. This includes all oncology-related chemotherapeutic drugs and supportive agents and radiation oncology treatments. This requirement applies to Medicare members 18 years of age and older.

Wellcare has also partnered with Evolent/NCH to implement a new cardiology prior authorization program, the Cardiology Management Program. This program is intended to help providers easily and effectively deliver quality patient care. Effective December 1, 2024, cardiology services rendered in a physician’s office, in an outpatient hospital ambulatory setting, or in an inpatient setting (planned professional services only) must be submitted to Evolent/NCH for prior authorization. Approvals issued by Wellcare before December 1, 2024, are effective until the authorization end date, but all prior authorization requests needed after December 1, 2024, must be submitted to Evolent/NCH. This prior authorization management program will apply to your Ambetter from Nebraska Total Care (Exchange), and Wellcare (Medicare) members 18 years of age and older.

Prior authorization can be requested by:

• Visiting Evolent/NCH’s Web portal, or
• Calling 1-888-999-7713, Option 1 (Monday–Friday, 8 a.m.–8 p.m. EST)

A provider network specialist will contact you to schedule an introductory meeting and training. If you have any questions prior to the introductory meeting, please contact Evolent/NCH at 1-888-999- 7713, Option 6 or email providertraining@newcenturyhealth.com. You can also self-register online at New Century Health website.