Reviewed: 4/30/2025
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ConnectiCare Oncology Drug Management Program
Evolent, formerly New Century Health (NCH), is a comprehensive quality management company that ConnectiCare has designated as its utilization review agent. Evolent offers collaboration and peer-to-peer discussions with oncologists’ and physicians’ offices. They have a provider web portal where you can request preauthorizations, select treatment care pathways, obtain help with documentation, and more.
As of Jan. 1, 2021, Evolent handles utilization management for most oncology-related chemotherapeutic drugs and supportive agents when delivered in the physician’s office, outpatient hospital, or other ambulatory setting. Evolent emphasizes and supports the selection of Preferred Pathways for adult oncology patient care.
Evolent manages medical specialties providing cancer care and its supportive services, including medical oncology, hematology, urology, and gynecologic oncology.
The following services are excluded from the Evolent program:
- Requests for patients under 18 years of age.
- Equipment requests (e.g., IV pump).
- Inpatient requests.
- Hemophilia drugs.
- Bone marrow transplants.
- Inpatient chemotherapy services.
- ESRD patients.
- Clinical trials.
- Radiopharmaceuticals.
- All places of treatment and services not specifically listed above.
Register to use Evolent’s provider portal which is always available and offers:
- Real-time authorizations for oncology treatment care pathways.
- Reduced documentation requirements.
- View of real-time status of preauthorization requests.
- Eligibility verification.
You may request training on the provider portal. You may also contact Evolent Network Operations at 888‑999‑7713, option six, 8 a.m. to 8 p.m., Monday through Friday.
Preauthorization
The Evolent program offers many benefits including:
- Peer-to-peer consultations by medical oncologists.
- Quick turnaround time on preauthorization requests submitted via portal, fax, or phone.
Evolent’s provider portal is always available, offering:
- Real-time authorizations for oncology treatment care pathways.
- Reduced documentation requirements.
- View of real-time status of preauthorization requests.
- Eligibility verification.
You can fax preauthorization request forms to 877-624-8602. Supportive telephonic authorization staff is available at 888-999-7713, 8 a.m. to 8 p.m., Monday through Friday.
An Evolent provider representative is available for support as needed.
Evolent medical reviewers are licensed medical oncologists.
If the request does not meet evidence-based treatment guidelines, Evolent may request additional information or initiate a peer-to-peer conversation with the requesting provider.
The reviewers use nationally recognized clinical guidelines when performing reviews. These guidelines are available on Evolent’s provider portal or by contacting Evolent’s Utilization Management at 888-999-7713, option six, 8 a.m. to 8 p.m., Monday through Friday.
The preauthorization review process applies to services rendered (e.g., chemotherapy administration) in an outpatient setting, which could include:
- Physician’s office.
- Infusion centers.
- Outpatient hospital locations.
- Other ambulatory care settings.
Inpatient authorization for chemotherapy should be submitted to Express Scripts:
Express Scripts Pharmacy Drug Reviews for:
- Commercial members: Call 844-516-3324, 24 hours a day, seven days a week, 365 days a year.
- Medicare members: Call 877-920-1470, 24 hours a day, seven days a week, 365 days a year.
- You can also fax requests to 877-251-5896.
Express Scripts Medical Drug Reviews for:
- Commercial and Medicare members: call 877-681-9866, 8 a.m. to 7 p.m., Monday through Friday, or fax to 866-896-1209.
Claims
ConnectiCare is responsible for grievance and appeals. Providers can initiate a grievance or appeal with ConnectiCare by mail or fax:
Line of Business |
Fax # |
Mailing Address |
|---|---|---|
Medicare |
Standard – 866-854-2763 Expedited – 866-350-2168 |
PO Box 2844 New York, NY 10116 |
Commercial |
Standard – 212-510-5320 Expedited – 866-350-2168 |
