Oncology Care Model
Oncology and Cardiology Quality Management
For a copy of our Privacy Notice, email our Compliance/Privacy Officer at email@example.com or call the Compliance Hotline at 877-305-1941
For a copy of our Patient Rights and Responsibilities document, email our Quality Management Department at Quality Management Department or call the Quality Management Department at 888-999-7713. You can also download the Patient Rights and Responsibilities document Here
To access clinical review criteria utilized for Commercial Member requests in Connecticut, access Aetna Clinical Policy Bulletins at https://www.aetna.com/health-care-professionals/clinical-policy-bulletins.html
To access clinical review criteria utilized for ConnectiCare Commercial Member requests in Connecticut, access ConnectiCare Medical Management Pharmacy Policies at https://www.connecticare.com/providers /commercial/pharmacy-policy.aspx
New Century Health applies nationally recognized clinical criteria and standards of care to medical necessity reviews. As available, CMS National and Local Coverage Determination Criteria and Medicare Guidance and CMS recognized Compendia are utilized for Medicare Advantage service requests. Health Plan specific clinical policies and nationally recognized oncology and cardiology consensus guidelines and compendia are applied for Commercial member reviews.
Clinical criteria utilized to issue an authorization are available upon request by contacting the NCH Health Utilization Department at:
New Century Health
675 Placentia Avenue, Suite 300
Brea, CA 92821
(888) 999-7713, option 1
New Century Health’s policy states that utilization review decisions are based only on medical necessity, appropriateness of care and service and the existence of coverage. There are no rewards, bonuses or incentives for practitioners or other individuals for issuing denials or approvals of coverage, service or care. There are no financial incentives for utilization management decision makers to encourage decisions that would result in underutilization or over-utilization. All medical necessity determinations are based upon nationally recognized standards of care and clinical guidelines and are not influenced by financial or in-kind incentives.