June 15, 2023
Wellcare is beginning its collaboration with New Century Health (NCH) to implement a new prior authorization program.
Who is New Century Health?
NCH is a comprehensive oncology quality management (OQM) and cardiology management specialty company optimizing the application of evidence-based medicine for the delivery of adult ambulatory cancer care and cardiology care.
Beginning July 1, 2023: The following interventional cardiology services will require a prior authorization from NCH before services are rendered in a physician’s office, outpatient hospital, inpatient hospital (planned/elective services only), or ambulatory setting:
- Aortic Valve Surgery
- Bypass Graft In-Situ Vein
- Bypass Graft Vein
- Cardiac Catheterization
- Congenital Health Disease Surgery
- Coronary Artery Disease Surgery
- Device Implantation/Electrical Cardioversion
- Device Monitoring
- Electrophysiology Studies (EPS)
- Endovascular Interventions
- Excision, Exploration, Repair, Revision
- Interventional Cardiology
- Interventional Radiology
- Left Atrial Appendage Closure
- Mitral Valve Surgery
- Pulmonary Artery Surgery
- Pulmonary Valve Surgery
- Repair/Excision for Aneurysm, Occlusive Disease, etc.
- Therapeutic Services
- Tricuspid Valve Surgery
*93745- Life Vest Programming (Related to Electrophysiology)
This prior authorization requirement applies to your Wellcare Medicare Advantage members ages 18 and older for the following lines of business: HMO, PPO, PPO-DSNP, DSNP, PFFs, and C-SNP.
We are also offering in-service/NCH portal training sessions via webinar for your prior authorization team. This meeting will take approximately 60 minutes and we will demonstrate how to submit prior authorizations via the NCH portal as well as other available features and tools/resources.
Please reply to me as to which session(s) is best for you and I will send a calendar invite that you can share with your prior authorization team:
Prior Authorization In-Service Sessions:
- June 27, 11 – 12 CST
- June 27, 2-3 CST
- June 28, 8 – 9 CST
- June 28, 12-1 CST
- June 29, 9-10 CST
- June 29, 1 – 2 CST
- June 30, 10 – 11 CST
PDW Provider Demographic Information: Please complete and return the attached PDW Provider Demographic Information worksheet, as this information will be used to create login credentials to the NCH on-line portal and to load your practice and providers.
- First Tab – Physician Information
- Second Tab – Prior Authorization Staff
- Third Tab – Business Leadership Information
Additionally, please reference the attached FAQ and provider notification letter for details and thank you for your assistance as we work together to assure you and your team are set for success beginning July 1, 2023.
PDW Provider Demographic Information