Oncology and Radiation Oncology

Date: 10/17/24

Nebraska Total Care has partnered with Evolent (formerly New Century Health) to implement a new prior authorization program. Evolent is a comprehensive oncology and radiation oncology quality management company will implement a new oncology and radiation oncology prior authorization program. The program will simplify the administrative process for providers to support the effective delivery of quality patient care.

Effective December 1, 2024, oncology-related infused oncology-related infused chemotherapeutic drugs, supportive agents, symptom management medications, and radiation oncology will require a prior authorization from Evolent before being administered in either the provider office, outpatient hospital, ambulatory setting, or infusion center. Treatment plans will be reviewed using nationally recognized evidence-based guidelines.

Prior authorization requirements will apply to your Ambetter from Nebraska Total Care (Exchange), and Wellcare (Medicare) members of all ages, and to the provider specialties of Medical Oncology/Hematology, Pediatric Oncology, Gynecology, Surgical Oncology, Neuro-Oncology, Urology, and Radiation Oncology.

Evolent offers providers:

• Real-time authorizations for approvable treatment plans submitted via the Evolent on-line portal https://my.newcenturyhealth.com.
• A telephonic option for requests at 1-888-999-7713, (Oncology - Option 2) (Radiation Oncology – Option 3) Staff is available Monday-Friday, from 7:00 a.m. to 7:00 p.m. CST.
• Real-time member eligibility verification through the Evolent portal prior to entering a treatment plan.
• Oncologists and radiation oncologists on staff for clinical discussions with physicians.

Ambetter from Nebraska Total Care (Exchange), and Wellcare (Medicare) approvals issued before December 1, 2024, are effective until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. If authorization is not
obtained from Evolent, claims may be denied. Oncology or radiation oncology services/treatment that did not require an authorization prior to December 1, 2024, will require an authorization from Evolent for service/treatment dates on and after December 1, 2024.

A Provider Solutions Manager will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please contact Evolent at 1-888-999-7713, (Option 6) or via email providertraining@evolent.com.