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 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.