New Century Health is committed to helping physicians deliver quality care and achieve their practice management objectives. Our company’s roots were developed by aiding medical specialists, so we understand many of the challenges facing physicians. Our oncology and cardiology care management programs and value based and core technology platform have been specially designed to:

  • Reduce your administrative burden

  • Provide you with support tools to enhance the delivery of quality patient care

  • Strengthen your practice economics

Clinical Criteria for Health Utilization Management Decisions

New Century Health applies nationally recognized clinical criteria and standards of care to medical necessity reviews. As available, CMS National and Local Coverage Determination Criteria and Medicare Guidance and CMS recognized Compendia are utilized for Medicare Advantage service requests. Health Plan specific clinical policies and nationally recognized oncology and cardiology consensus guidelines and compendia are applied to for Commercial member reviews.

Clinical criteria utilized to issue an authorization are available upon request by contacting the NCH Health Utilization Department at:
New Century Health
675 Placentia Avenue, Suite 300
Brea, CA 92821
(888) 999-7713, option 1


Connecticut Criteria
To access clinical review criteria utilized for Aetna Commercial Member requests in Connecticut, access Aetna Clinical Policy Bulletins at

To access clinical review criteria utilized for ConnectiCare Commercial Member requests in Connecticut, access ConnectiCare Medical Management Pharmacy Policies at

Affirmative Statement
New Century Health's policy states that utilization review decisions are based only on medical necessity, appropriateness of care and service and the existence of coverage. There are no rewards, bonuses or incentives for practitioners or other individuals for issuing denials or approvals of coverage, service or care. There are no financial incentives for utilization management decision makers to encourage decisions that would result in underutilization or over-utilization. All medical necessity determinations are based upon nationally recognized standards of care and clinical guidelines and are not influenced by financial or in-kind incentives.

Reducing Administrative Burden and Enhancing Care

The point-of-care physician prior authorization platform is easily integrated into the physician’s practice and is designed to have the physician treat patients as quickly as possible.

  • The web-based platform means that there is no expensive technology to purchase

  • Treatment requests are submitted with a simple online form that takes minutes to complete. Providers can receive instant approvals for evidence-based care

  • Complex cases receive specialist-to-specialist peer review, to ensure that patients receive quality, evidence based care

  • New Century Health uses Scientific Advisory Boards to guide the development, review and approval of our clinical guidelines

  • We collaborate with leading regional providers to ensure that appropriate standards of care inform our guidelines