Submitting Cardiology Prior Auth Requests
03/05/2021
Background:
Passport Health Plan by Molina Healthcare will continue its collaboration with New Century Health (NCH), a cardiology quality management company, to administer prior authorizations.
Effective February 1, 2021, the Kentucky Department for Medicaid Services (DMS) reinstated prior authorization requirements for outpatient services.
- Prior Authorizations for outpatient services resumes effective February 1, 2021. DMS has posted to its website the updated Prior Authorization Guidance that is effective February 1, 2021. Please refer to the DMS website to review this information.
- NCH will now administer prior authorizations. NCH will base their scope on the CPT code instead of taxonomy. You may now be required to submit an authorization request through NCH even though it was previously not required for you.
Q: How can a provider request access to NCH’s on-line portal access?
A: By registering at https://my.newcenturyhealth.com/
Q. How can a provider request additional training on NCH processes?
A: Contact NCH Network Operations at (888)999-7713 - Option 6
or
Contact NCH’s Provider Network Manager, Rachel Vowels:
Email: rvowels@newcenturyhealth.com
Cell: 562-237-3174
Fax: 502-901-4260
More info about New Century Health (NCH), a cardiology quality management company, will continue to require a prior authorization before services are provided in either a provider office, outpatient setting, inpatient setting or ambulatory surgical center. This prior authorization requirement applies to Medicaid members ages 18 and over (minors go through Availity) for the following services:
- Non-invasive cardiology,
- Non-invasive vascular,
- Cardiac Cath and interventional cardiology,
- Vascular radiology and intervention
- Vascular surgery,
- Thoracic surgery,
- Cardiac surgery,
- Electrophysiology
The benefits of Passport partnering with NCH for cardiology services include:
- The use of clinical criteria, based on nationally recognized guidelines, to promote quality care
- Increased collaboration with physician offices to foster a team approach
- Physician discussions with true peers, cardiologists who can understand and better discuss treatment plans
A provider web portal to:
- Obtain real-time approvals when selecting evidence-based NCH treatment care pathways
- Determine which clinical documentation is necessary for medical review
- View all submitted requests for authorization in one location
- Check member eligibility
Provider Action Needed:
- To determine if an authorization is required, please use the Prior Authorization Look Up tool https://www.molinahealthcare.com/members/ca/en-US/health-care-professionals/home.aspx
Scroll to Need a Prior Authorization? Then tap the Code LookUp Tool button. Enter the CPT for directions on how to submit a prior authorization.
- New Century Health authorization requests can be submitted on their portal at https://my.newcenturyhealth.com/
Questions:
For questions, please call the Provider Contact Center, (800) 578-0775 or contact your provider services representative.
2021 Passport Health Plan by Molina Healthcare (Molina-512)