CommunityCare is excited to notify you that effective Friday, November 1, 2024, Evolent (formerly New Century Health) will begin managing prior authorizations for most oncology-related services.
As previously noted in a late July notification, the following will require a prior authorization from Evolent before being administered in either the provider office, outpatient hospital, ambulatory setting or infusion center: physician administered and oncology-related infused and injectable chemotherapeutic drugs, supportive agents, symptom management medications and radiation oncology treatment requests.
Treatment plans will be reviewed using nationally recognized evidence-based guidelines and not be more restrictive than CMS criteria.
Prior authorization requirements will apply to all CommunityCare Commercial and Marketplace members of all ages and Medicare Advantage members 18 years of age and older.
Please note the following:
• Real-time authorizations for treatment plans meeting best evidence-guided therapy may be submitted via the Evolent CarePro provider portal at https://my.newcenturyhealth.com.
o The Evolent CarePro provider portal may also be accessed from a link in the CommunityCare provider portal, CareWeb.
• Authorization status updates will be available in the Evolent CarePro provider portal.
o After determination, authorizations will also show in CommunityCare’s provider portal, CareWeb.
• Telephone authorization requests – Providers needing to request an authorization may call 1-888-999-7713, (Oncology – Option 2) (Radiation Oncology – Option 3). Staff are available Monday-Friday, from 7 a.m. to 7 p.m. CST
• Oncologists and radiation oncologists are on staff for clinical discussions with physicians.
• A dedicated Evolent Provider Solutions Manager is available to contact directly for any issues or questions.
All prior authorizations for surgical oncology treatment after November 1, 2024, should be directed to CommunityCare via the CareWeb portal.
Any CommunityCare prior authorizations approved before November 1, 2024, are effective and valid until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. For services/treatment that did not require an authorization prior to November 1, 2024, an authorization may be required from Evolent for service/treatment dates on and after November 1, 2024.
If your office has not been contacted by an Evolent Provider Solutions Manager to schedule an introductory meeting and training session to prepare users for the upcoming transition, please contact Evolent at 1-888-999-7713, (Option 6) or via email at .
If you have questions, please contact CommunityCare’s Medical Management department at (918) 594-5228 or (800) 594-0089 or contact your Provider Services Representative.