Evolent Oncology Prior Authorization Changes

5/1/2024

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

Effective June 1, 2024, infused, injectable and oral chemotherapy, hormonal therapeutic treatment, supportive agents, and symptom management medications and radiation oncology requests will require a prior authorization from Evolent before being administered in either the provider office, outpatient hospital, ambulatory setting, or infusion center. Treatment plans will be reviewed using nationally recognized evidence-based guidelines.

Prior authorization requirements will apply to your Ambetter from Meridian Michigan (Exchange), MeridianComplete (Medicare-Medicaid Plan), and Wellcare Complete by Allwell Michigan (Medicare), members 18 years of age and older. This program includes the specialties of gynecologic oncology, hematology, medical oncology, neuro-oncology, surgical oncology, urology, and radiation oncology.

Evolent offers providers:

• Real-time authorizations for approvable treatment plans submitted via the Evolent CarePro provider portal https://my.newcenturyhealth.com.
• A telephonic option for requests at 1.888.999.7713, medical oncology (option 2) radiation oncology (option 3). Staff is available Monday-Friday, from 7:00 a.m. to 7:00 p.m. CST.
• Real-time member eligibility verification through the Evolent CarePro portal prior to entering a treatment plan.
• Oncologists and 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.

Ambetter from Meridian Michigan, MeridianComplete, and Wellcare Complete by Allwell Michigan approvals issued before June 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 June 1, 2024, an authorization will be required from Evolent for service/treatment dates on and after June 1, 2024.

A Provider Solutions Manager will contact you soon to schedule an introductory meeting and in-service 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.

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