The Humana Oncology Quality Management Program, founded on evidence-based care standards, uses a counseling model within traditional preauthorization management for chemotherapeutic drugs, symptom-management drugs and supporting agents.

This program is administered by New Century Health for patients with Humana commercial and Medicare Advantage (MA) plans and some administrative-services-only members in the following states:

  • Alabama
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Idaho
  • Illinois (including Dual Medicare-Medicaid)
  • Indiana (please see below for special instructions)
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Mexico
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • South Carolina
  • South Dakota
  • Tennessee
  • Utah
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming

The terms prior authorization, precertification, preadmission and preauthorization all refer to the preauthorization process.

Preauthorization is not required for patients with Humana MA private fee-for-service (PFFS) plans or for services provided by nonparticipating healthcare providers to patients with MA preferred provider organization plans. Nor is notification required for these plans; however, it is requested, as it helps coordinate care for your patients.

New Century Health does not review preauthorization requests from health care providers who participate in an independent practice association (IPA) or other risk network with delegated services. These healthcare providers should refer to their IPA or risk network for guidance on processing preauthorization requests.

Submitting preauthorization requests

Choose from the following options to submit a request for preauthorization:

  1. Log on to New Century Health’s website at my.newcenturyhealth.com. , opens new window Enter your username and password, and submit your request. If you need a username and password, call New Century Health at 1-855-427-1372, option 1.
  2. Call New Century Health’s intake coordinator department at 1-855-427-1372, option 1, Monday – Friday, 8 a.m. – 8 p.m., Eastern time.
  3. To fax, choose the standard or relevant state-specific form from the Important links box on the right. Fill out the form and fax it to 1-877-624-0611.

Questions

For answers to questions about this program, call 1-855-427-1372, option 1 available Monday – Friday, 8 a.m. – 8 p.m., Eastern time.

View documents that list services and medications for which preauthorization may be required for patients with Humana Medicaid, Medicare Advantage, dual Medicare-Medicaid and commercial coverage.