CurrentFidelis CarePolicy N/A

Medicaid Managed Care & HealthierLife

Requires review by New Century Health before dispensing or administration of listed oncology medications and supportive agents for Fidelis Care Medicaid Managed Care & HealthierLife members (adults 18+; pediatric included starting 2022-07-01). Includes an out-of-scope list, preferred biosimilars, and an extensive HCPCS/J-codes list requiring prior authorization.

Policy Summary

PayerFidelis Care

PolicyMedicaid Managed Care & HealthierLife

Policy CodePolicy N/A

Change TypeNo material change

Effective Date

Next Review Date

Key ActionProviders must submit the entire oncology regimen to New Century Health via my.newcenturyhealth.com or 1-888-999-7713 (option 1) for listed HCPCS/J-codes prior to dispensing or administration; omissions may result in denial.

SourceLink

POLICY UPDATE CHANGES

No material clinical/coverage changes — policy requirements unchanged.

150+HCPCS/J/Q codes listed requiring PA

5Preferred biosimilars listed

15Out-of-scope item categories

my.newcenturyhealth.comNCH web portal

Policy summary

Fidelis Care requires utilization review of oncology medications and supportive agents through New Century Health (NCH) before outpatient dispensing or administration for Medicaid Managed Care & HealthierLife members; requests must be submitted via NCH's web portal (my.newcenturyhealth.com) or by calling 1-888-999-7713, option 1. This requirement applies to members age 18 and older, with pediatric members included starting 7/1/2022. The policy lists drugs by HCPCS/J/Q codes that require prior authorization and specifies items that are out of scope; providers must submit the entire oncology regimen to NCH (omissions may result in denial).

PayerFidelis Care

PolicyOncology medications/supportive agents prior authorization via New Century Health (NCH)

Policy NumberN/A

Effective Date

Scope summaryRequires review by New Century Health before dispensing or administration of listed oncology medications and supportive agents for Fidelis Care Medicaid Managed Care & HealthierLife members (adults 18+; pediatric included starting 2022-07-01). Includes out-of-scope list, preferred biosimilars, and HCPCS/J-code list requiring prior authorization.

StatusCURRENT

HCPCS/J/Q codes listed requiring PA150+

Preferred biosimilars listed5

Out-of-scope item categories15