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Ambetter of North Carolina Provider Notification NCH

Date: 08/10/21

Dear Provider,

Ambetter of North Carolina Inc. is pleased to announce its collaboration with New Century Health (NCH), an oncology quality management company, to implement a new prior authorization program. The program will simplify the administrative process for providers to support the effective delivery of quality patient care.

Beginning November 1, 2021, all oncology-related infused, oral chemotherapeutic drugs/supportive agents, and radiation treatments will require a prior authorization from NCH before being administered in either the provider’s office, outpatient hospital, ambulatory setting, or infusion center.  This requirement applies to Ambetter of North Carolina members of all ages.

Benefits 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
  • Physician discussions with medical oncologists or radiation oncologists who can understand and 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 needed for medical necessity review.
    • View all submitted requests for authorization in one location.
    • Check member eligibility.

Prior Authorization Process:

The requesting physician must complete an authorization request using one of the following methods:

Monday–Friday 8 AM to 8 PM EST

Medications Impacted:

Ambetter of North Carolina’s Oncology Pathway Solutions Program, administered by New Century Health, requires prior authorization management for all chemotherapeutic drugs, symptom management drugs and supporting agents for members with a cancer or hematology diagnosis code.

Specialties included are Medical Oncology/Hematology, Pediatric Medical Oncology/Hematology Gyn-Oncology, Neurological Oncology, Radiation Oncology, Pediatric Radiation Oncology, Surgical Oncology, Urology, Pediatric Urology (medications only).

Transition of Care:

Authorizations previously issued by Ambetter of North Carolina UM before 11/01/2021 will be effective until the authorization expiration date. Authorizations previously issued by Ambetter of North Carolina UM that expire on or after 11/01/2021 must be submitted to New Century Health to obtain a new valid authorization.

Authorizations for a single drug regimen issued by Ambetter of North Carolina or Envolve Pharmacy Solutions before 11/01/2021 will remain valid until they expire.      

A New Century Health representative will contact you soon to schedule an introductory meeting and training. Should you have any questions, please contact NCH’s Network Operations at 1-888-999-7713, Option 6.

We look forward to offering you this program and hope that it will enhance your experience with your oncology service authorizations.  




Ambetter North Carolina Inc.