The Humana Oncology Quality Management Program, founded on evidence-based care standards, utilizes 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 Humana commercial, Medicare Advantage (MA) and some administrative-services-only members in the following states:
- Illinois (including Dual Medicare-Medicaid)
- Indiana (please see below for special instructions)
- New Mexico
- North Carolina
- North Dakota
- South Carolina
- South Dakota
- West Virginia
In addition, New Century Health administers this program for dual Medicare-Medicaid members in Illinois.
The terms prior authorization, precertification, preadmission and preauthorization all are used to refer to the preauthorization process. For MA Private Fee-for-Service (PFFS) members and for services provided by nonparticipating health care providers for MA PPO members, preauthorization is not required. Notification is requested for these plans, but not required, as this helps coordinate care for our members.
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 health care providers need to 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:
- Initiate an online preauthorization request by logging on to New Century Health’s website at , opens new window Enter your username and password. If you have not yet received a username and password, please call New Century Health at 1-855-427-1372, option 1.
- Contact New Century Health’s intake coordinator department at 1-855-427-1372, option 1, to submit a request by phone. Assistance is available Monday through Friday between 8 a.m. and 8 p.m. Eastern time.
- Physicians and other clinicians in Indiana may use the to submit preauthorization requests for their Humana-insured patients with commercial coverage. Instructions are included on the form. Once complete, please fax it to New Century Health at 1-877-624-0611. Include supporting clinical documentation (e.g., medical records, progress notes, lab reports, radiology studies, etc.) with your fax form.
Submit preauthorization requests via telephone at 1-855-427-1372, option 1 (available Monday – Friday, 8 a.m. – 8 p.m., Eastern time).
Preauthorization and notification lists
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.
Consult Online tutorial
Learn how to request, schedule and follow up on imaging services and treatment plans for your Humana-insured patients online with Consult Online by reviewing this tutorial.