New Evolent Oncology Program – Authorization Codes Beginning May 1, 2024

WellCare of North Carolina (WellCare) is pleased to announce its collaboration with Evolent (formerly New Century Health), an oncology quality management company, to implement a new radiation oncology prior authorization program. The program will simplify the administrative process for providers to support the effective delivery of quality patient care.

Effective May 1, 2024, radiation oncology services will require a prior authorization from Evolent before being administered in either the provider office, outpatient hospital, or ambulatory setting. Treatment plans will be reviewed using nationally recognized evidence-based guidelines. Prior authorization requirements will apply to your WellCare Medicaid members, of all ages, and to the provider specialty of Radiation Oncology.

See a list of the Authorizations codes (PDF) and important FAQs (PDF) for more information.

Evolent offers:

▪ Real-time authorizations for approvable treatment plans submitted via the Evolent on-line portal https://my.newcenturyhealth.com.
▪ A telephonic option for requests at 1-888-999-7713, (Radiation Oncology – Option 3) Staff is available Monday-Friday, from 8:00 a.m. to 8:00 p.m. EST.
▪ Real-time member eligibility verification through the Evolent portal prior to entering a treatment plan
▪ Radiation oncologists on staff for clinical discussions with physicians.
▪ A dedicated Evolent Provider Solution Manager to use as a direct point-of-contact for any issues or questions.

WellCare approvals issued before May 1, 2024, are effective until the authorization end date. Upon expiration, authorization requests must be submitted to Evolent. If authorization is not obtained from Evolent, claims may be denied. For services/treatment that did not require an authorization prior to May 1, 2024, an authorization will be required from Evolent for service/treatment dates on and after May 1, 2024.

A Provider Solutions Manager will contact you soon to schedule an introductory meeting and training. Should you have any questions prior to the introductory meeting, please contact Evolent at 1-888-999-7713, (Option 6) or via email providertraining@newcenturyhealth.com. For any other questions, reach out to your WellCare provider rep or email ncproviderrelations@wellcare.com.

We look forward to offering you this program and hope it will enhance your experience with radiation oncology service authorizations.