Wellcare Cardiology Management Program Frequently Asked Questions
Effective July 1, 2023
What is New Century Health (NCH)?
NCH is a comprehensive oncology quality management (OQM) and cardiology management specialty company whose goal is the application of evidence-based medicine for the delivery of adult ambulatory cancer care and cardiology care.
What is the Wellcare Cardiology Management Program?
The Wellcare Cardiology Management Program provides prior authorization management for cardiology services rendered in a physician’s office, in an outpatient hospital ambulatory setting, or in an inpatient setting (planned professional services only). The program emphasizes and supports the selection of preferred pathways for patient care and is administered by New Century Health.
Is this for all Wellcare members?
The Wellcare Cardiology Management Program is for Wellcare Medicare members ages 18 and older who are enrolled in the following lines of business: HMO, PPO, PPO-DSNP, DSNP, PFFs, and C-SNP.
When will the Wellcare Cardiology Management Program begin?
The program will begin July 1, 2023.
How can a physician’s office request training for this program?
A provider network specialist will contact you to schedule an introductory meeting and training. If you have any questions prior to the introductory meeting, please contact NCH at 1-888-999-7713, (option 6), or email providertraining@newcenturyhealth.com. You can also self-register online at my.newcenturyhealth.com or call Wellcare directly at 1-855-538-0454.
What are some key features of the program?
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The online provider portal is always available, offering:
- Real-time authorizations for treatment care pathway
- Real-time status of authorization requests
- Eligibility verification
- Authorization support staff are available at 1-888-999-7713, (option 1), Monday through Friday, from 5 a.m. to 5 p.m., PST
- Quick turnaround time on authorization requests submitted via portal or phone
- Physician discussion by cardiologists
- New Century Health provider representatives are available for support as needed
What is the transition of care process?
Approvals issued by Wellcare before July 1, 2023, are effective until the authorization end date. Starting July 1, 2023, please submit prior authorization requests to NCH.
Who should obtain prior authorization?
The physician organization ordering the cardiology services must request prior authorization through New Century Health.
How do I obtain prior authorization?
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Submit cardiology service requests to New Century Health via one of the following methods:
- Logging into New Century Health’s provider web portal at my.newcenturyhealth.com
- Contacting New Century Health’s Utilization Management Intake Department at
1-888-999-7713, (option 1), Monday through Friday, from 5 a.m. to 5 p.m., PST
What is the turn-around time (TAT) for processing prior authorization requests?
- Standard Medical: 14 calendar days
- Expedited Medical: 72 hours
What services/specialists are included in the Wellcare Cardiology Management Program?
- The program will apply to all specialties for the following interventional cardio services only:
- ABLATION
- ANGIOGRAPHY
- AORTIC VALVE SURGERY
- BYPASS GRAFT IN-SITU VEIN
- BYPASS GRAFT VEIN
- CARDIAC CATHETERIZATION
- CONGENITAL HEART DISESE SURGERY
- CORONARY ARTERY DISEASE SURGERY
- DEVICE IMPLANTATION/ELECTRICAL CARDIOVERSION
- DEVICE MONITORING
- ELECTROPHYSIOLOGY STUDIES (EPS)
- ENDOVASCULAR INTERVENTIONS
- EXCISION, EXPLORATION, REPAIR, REVISION
- STRIPPINGS/LIGATIONS
- INTERVENTIONAL CARDIOLOGY
- INTERVENTIONAL RADIOLOGY
- LEFT ATRIAL APPENDAGE CLOSURE
- MITRAL VALVE SURGERY
- PULMONARY ARTERY SURGERY
- PULMONARY VALVE SURGERY
- REPAIR/EXCISION FOR ANEURYSM, OCCLUSIVE DISEASE, ETC.
- SAVR
- TAVR
- THERAPEUTIC SERVICES
- THROMBOENDARTERECTOMY
- TRICUSPID VALVE SURGERY
Who at New Century Health will be reviewing cardiology requests?
- New Century Health medical reviewers are licensed cardiologists using nationally recognized clinical guidelines when performing reviews. Guidelines are available at my.newcenturyhealth.com or by contacting New Century Health at 1-888-999-7713, (option 1)
- If the request does not meet evidence-based treatment guidelines, New Century Health may request additional information or initiate a physician discussion with the requesting provider
What will the New Century Health authorization look like, and how long is it valid?
The NCH authorization will start with “AR” followed by at least four digits (e.g., AR1000). It is valid for the duration indicated on the Service Request Authorization (SRA).
What place(s) of service does this prior authorization review process include?
The Wellcare Cardiology Management Program provides prior authorization management for cardiology services rendered in a physician’s office, in an outpatient hospital ambulatory setting, or in an inpatient setting (planned professional services only).
Does a prior authorization guarantee payment?
No, a prior authorization does not guarantee payment for services. Payment of claims is dependent on eligibility, covered benefits, provider contracts, and correct coding and billing practices. For specific details, please refer to your Provider Manual.
Who is responsible for responding to grievances and appeals?
Wellcare will continue to respond to member grievances and appeals. Members can continue to follow processes outlined on our website and in the Member Handbook to submit either a grievance or an appeal. Providers can initiate a grievance or appeal with Wellcare by following the processes outlined in your Provider Manual or by calling Provider Services at 1-855-538-0454.
What will happen if the physician does not request and obtain an authorization?
If a required authorization is not obtained, Wellcare may deny payment for the relevant services. Members cannot be held responsible or billed for denied charges / services. Providers may only collect the applicable cost share amount directly from the member.
