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Utilization Management Programs

National Imaging Associates (NIA)

Visit RADMD, a website managed by National Imaging Associates, Inc., designed primarily for imaging centers, hospitals and health plans. This user-friendly, online service provides up-to-the hour information on a member's authorization including date called, date approved, exam category, valid billing codes (CPT) and much more.

 

Provider Administered Drug Program (PADP)

Visit Magellan Rx Management, a website managed by Magellan Health, Inc., click on the Providers and Physicians tab to access their secure provider self-service tool to obtain a pre-service review of a drug included in Provider Administered Drug Program (PADP) or validate authorization status. If a prior authorization request is pended, you will receive a tracking number that you can use to check status. If you need assistance with establishing a unique user name and password for your organization’s administrator, please click on Help.

Magellan Rx Management’s website cannot be used for retrospective or expedited authorization requests.

Note: Effective Jan. 1, 2021, prior authorization review for Medicare Advantage members for oncology and/or hematology indications will no longer be reviewed by Magellan Rx Management. All prior authorization requests will be submitted and performed by New Century Health. If used for a non-oncology and/or non-hematology indication, the prior authorization requests will continue to be submitted and performed by Magellan Rx Management.

 

Oncology and Hematology Prior Authorization Program for Medicare Advantage Members

As of Jan. 1, 2021, prior authorization requests associated with oncology and/or hematology indications for Medicare Advantage members will go through New Century Health, an oncology and hematology quality management company.

Medical oncology, hematology, surgical oncology, gynecologic oncology, urology provider specialties and radiation oncology treatments will require prior authorization by New Century Health before being administered in the provider’s office, outpatient hospital, ambulatory setting or infusion center. See Prior Authorization Process section below.

Requests received prior to Jan. 1, 2021 will remain in effect until the authorization end date. Upon expiration, authorization requests must be submitted to New Century Health for the above-mentioned specialty services.

Please note: Self-administered oral oncology/hematology drugs covered under the pharmacy benefit along with supportive treatments will continue to be reviewed by our pharmacy benefits manager, Prime Therapeutics.

Facility Policy:
A separate facility authorization will not be needed for drug administration services.

Prior Authorization Process:
Providers will use the New Century Health provider portal to submit authorization requests for drugs or radiation oncology associated with an oncology and/or hematology diagnosis. See code detail here.

The requesting physician must complete an authorization request using one of the following methods:

  • Log into the New Century Health provider web portal: my.newcenturyhealth.com
  • Call 1-888-999-7713 (Monday–Saturday, 8 a.m. to 8 p.m. ET)
    • Medical Oncology – Option 1
    • Radiation Oncology – Option 2

New Century Health may approve chemotherapeutic and supporting agents, including hematology drugs or radiation oncology requests for a period of up to 90 days.

Program Frequently Asked Questions (FAQs)
For more program details, refer to the Oncology and Hematology Prior Authorization program FAQs.

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