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:
- Illinois (including Dual Medicare-Medicaid)
- Indiana (please see below for special instructions)
- New Mexico
- North Carolina
- North Dakota
- South Carolina
- South Dakota
- West Virginia
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.