SilverSummit Healthplan oversees the NIA program and is responsible for claims adjudication. Contact eviCore for changes to the facility or service. Coordinated Care has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management and post-service review of physical therapy, occupational therapy and speech therapy services.. Radiology Services. Certain non-emergent outpatient cardiac procedures require prior authorization. Outpatient Medicaid Prior Authorization Form (PDF) Coming Soon; Inpatient Medicaid Prior Authorization Form (PDF) Coming Soon; Provider Appeal Form (PDF) Coming Soon; Pharmacy Retail Prior Authorization Form (PDF) Coming Soon; Telemedicine Guide (PDF) Coming Soon; Wellcare Forms. To submit a request for prior authorization providers may: Call the prior authorization line at 1-866-263-9011. This program is consistent with industry-wide efforts to . The written appeal should include the following information: Provider name. Behavioral Health: 866-570-7517. The requested clinical should be faxed to Medical Management, using the appropriate fax number for the service for which authorization is requested. National Imaging Associates, Inc. (NIA) Frequently Asked Questions (FAQ's) Prior Authorization Program Physical Medicine Services (PDF) Physical Medicine Program Provider . Oklahoma Complete Health has contracted with National Imaging Associates Inc. (NIA) (link redirects to an external website), an affiliate of Magellan Health Services, for radiology benefit management.. Prior Authorization Program Physical Medicine Services 1 — Ambetter from Superior HealthPlan - Outpatient Therapy Services QRG SHP_2020A7195A Effective January 1, 2021. Providers can also submit prior authorization telephonically at 1-800-642-7554 or through fax at 1-800-784-6864. Prior Authorization. National Imaging Associates, Inc. (NIA) will be providing utilization management for outpatient National Imaging Associates - Prior Authorization Requests Online, Phone or Fax for Physical, Occupational and Speech Therapy Services. eviCore will approve the CPT or HCPCS code or codes for the requested procedure. NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Nebraska Total Care oversees the NIA program and is responsible for claims adjudication. See the PA Latest News for more recent updates.. Ambetter from Buckeye Health Plan has Reduced Prior Authorization Requirements. Providers rendering the above services should verify that the necessary authorization has been obtained. Any services rendered on and after July 1, 2019 will require authorization. FOX News Rundown to discuss member of the actions taken or the. Providers can also submit prior authorization telephonically at 1-800-642-7554 or through fax at 1-800-784-6864. Peach State Health Plan has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. This program is consistent with industry-wide efforts to ensure . You can also check the status of your authorization or pre-approval by calling the Customer Service phone number on your member ID card. Submit online at National Imaging Associates or call 1-800-642-7820. Musculoskeletal Care. Please visit our new prior authorization website page to gain access to the secure portal and correct fax forms here.. PDF prior authorization form and fax it to 1-866-263-9036. Transparency - Easily track each request as it moves through the determination process. Failure to do so may . Many of our health plans require prior authorization for certain musculoskeletal (MSK) care procedures, including: Interventional pain management. Horizon NJ Health partners with eviCore healthcare (eviCore) to manage Advanced Imaging Services for our members through Prior Authorizations/Medical Necessity Determinations (PA/MND) with providers. PAF = Prior Authorization Request Form : MAPAF = Massachusetts Standard Form for Medication Prior Authorization . The authorization forms can be found in the Provider Resources section of this web site and should be faxed to (877) 212-6669, or submitted electronically via the secure provider portal.Participating providers may submit requests for therapy services and visit schedules starting on December 9, 2019 for dates of service on or after January 1, 2020, when those services are likely to exceed the . New Biopharmacy/Buy and Bill PA Form. For any questions or additional information, please contact NIA directly by email at RadMDSupport@MagellanHealth.com or by calling toll-free at 1-800-327-0641. . Clinical guidelines can be found by visiting the NIA website at www.RadMD.com. Pharmacy Prior Authorization Request; Medical/Behavioral Health Prior Authorization Form; Sterilization Consent; Authorization/ Pregnancy Risk Assessment; RSV (Synagis) Enrollment Form; Synagis® Auth Guidelines 2021 2022 (PDF) Care Management. NIA can be reached at www.RadMD.com or via NIA's call center at (800) 424-4836. National Imaging Associates, Inc. (NIA) (For advanced imaging requests) OHP/Medicaid & Medicare: 1-888-879-5922 Online submission: www.Radmd.com Trillium Behavioral Health (TBH) are authorized by National Imaging Associates. Call NIA at 1-800-424-4926 or visit the NIA website . Please note the following: The ordering physician must obtain authorization before rendering the previously listed services. In response to your feedback, Buckeye has removed 25 services from our prior authorization list effective March 31, 2021. Trillium Community Health Plan has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Express Scripts manages prior authorizations and Non-Formulary requests for Medicare Part D prescriptions. Inpatient Medicaid Prior Authorization Fax Form - English (PDF) Outpatient Medical Services: 1-866-724-5057 . Prior Authorization National Imaging Associates (NIA) Report Fraud, Waste and Abuse . To obtain authorization, the provider should go to www.RadMD.com, or through the NIA dedicated toll-free phone number for Medicare 1-800-424-5388.; Providers rendering the services previously listed should verify that the necessary authorization has been obtained by . Preferred Drug List (PDL) (PDF) Division of Medicaid Preferred Drug List Changes - Effective 10/1/2020 (PDF) Prior Authorization Forms. National Imaging Associates NIA Outpatient Radiology. Visit the NIA website to use this service, or call (888) NIA-BLUE (642-2583). We work with National Imaging Associates (NIA) Magellan Healthcare to manage radiology prior authorizations on behalf of BlueCross BlueShield of South Carolina. National Imaging Associates (NIA) Report Fraud, Waste and Abuse . We require prior authorization before you send someone to see one of our nonpreferred in-network or out-of-network providers, except for emergency, post-stabilization, and urgent care. Effective April 1st, 2022, . Absolute Total Care has contracted with National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health Services to provide utilization management for outpatient rehabilitative and habilitative physical medicine services. Provider Resources. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an . Adult Wellness Visit Checklist (PDF) Connections Referral Form (PDF) Foster Care Health Information Form (PDF) Primary Care Provider (PCP) Change Form (PDF) Pharmacy Reimbursement. Some services require prior authorization from NH Healthy Families in order for reimbursement to be issued to the provider. This program is consistent with industry-wide efforts to ensure clinically appropriate . Western Sky Community Care has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Member Forms. Michigan Complete Health oversees the NIA program and is responsible for claims adjudication. © 1999-2022 Magellan Health, Inc. All Rights Reserved. Provider Contracting and Credentialing. Clinician Administered Drugs (CAD): 1-866-683-5631. Hearing Aid Authorization Request MS-76 (PDF) Home Health Authorization Request MS-72 (PDF) Informed Consent for Hysterectomies and Completion Instructions (PDF) Inpatient Prior Authorization (PDF) MCNA Dental Therapeutic Treatment with Anesthesia Prior Auth Request. Additional resources are listed below are located on the Provider-Training webpage. Prior authorization can be obtained through the NIA website or by contacting NIA at 866-493-9441. Your doctor must contact Florida Blue's imaging coordinator, National Imaging Associates (NIA), at 1-866- 326-6302 or via RadMD.com. See our Prior Authorization Prescreen tool.You can also access the Provider Portal here.. Standard prior authorization requests should be submitted for medical necessity review at least fourteen (14) business days before the scheduled service delivery date or as soon as . The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program includes management of non-emergent, If you have any questions regarding this new prior authorization program, please contact the Fidelis Care Provider Call Center at 1-888-FIDELIS (1-888-343-3547). Phone: 1-866-972-9842 (must also send a written, signed appeal) Fax: 1-888-656-0701. Welcome to RadMD.com. Medicare Pre-Auth. Radiology Management Program Prior Authorization. Notification of Pregnancy Form (PDF) Known Issues and Resolution Timeframes; No Surprises Act Open Negotiation Form (PDF) National Imaging Associates (NIA) Documents. Medicaid/CHIP Prior Authorization Fax Numbers: Physical Health: 1-800-690-7030. National Imaging Association (NIA) manages prior authorization for MRI, PET, CT scans, nuclear cardiology, and radiation oncology procedures. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. MHS has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Prior authorization for these radiological exams is obtained from National Imaging Associates (NIA) or by calling 1-800-424-5657. This program is consistent with industry-wide efforts to ensure clinically . Contacts. Doctors can request prior authorization by signing in to My Insurance Manager ®, calling 877.440.0089 or faxing 612.367.0742. It's quick and easy. Medicare Part D Medications. Pharmacy Prior Authorization Request Forms. There are two ways to submit prior authorization: Through NIA's Website at www.RadMD.com, or by calling NIA at 1-866-326-6301. Maryland Heights, MO 63043. Express Scripts manages prior authorizations and Non-Formulary requests for Medicare Part D prescriptions. Date: 01/05/22 Effective December 1, 2021, Superior HealthPlan delegated utilization review for physical, occupational and speech therapy (PT, OT, ST) services that require prior authorization to National Imaging Associates (NIA) for the Superior's Medicaid . Auxiliary aids and services are subject upon mark to individuals with disabilities. . This program is consistent with . To obtain authorization, the provider must go to www.RadMD.com, or call NIA's toll-free numbers: 1-866-249-1583 (Medicaid) or 1-800-424-5388 (Medicare). Specialty Pharmacy and Specialty Infusion Programs. This link leads to a third party site. *Please see bullet below for prior authorization instructions for specified outpatient radiological procedures. National Imaging Associates (NIA) Arizona Complete Health has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. This program is consistent with industry-wide efforts to ensure . Provider Data Reporting and Validation Form QI Program HEDIS HEDIS Evaluation; Medical Records . The requirement applies when services are performed in an outpatient or office site of care. Absolute Total Care has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Pre-Auth Check. UPDATES TO PRIOR AUTHORIZATION GUIDELINES FOR IMAGING PROCEDURES Effective March 1, 2021 January 30, 2021 . Ambetter Pre-Auth Check Tool | Apple Health (Medicaid) Pre-Auth Check Tool. Care1st Care Management Referral Form - (11/30/2021) Credentialing . You may also submit a prior authorization request via NaviNet. A typical prior authorization is valid for up to one year. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. The OB/GYN is responsible for notifying the CareFirst CHPDC/Alere Case Manager at (202) 821-1100 for assistance with support services needed to help the pregnant . Contract Request Form Prior Authorization. Requirement: The following non-emergent, advanced, outpatient imaging procedures require prior authorization through NIA: CT/CTA California Health & Wellness has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. This program is consistent with industry-wide efforts to ensure clinically . PA Health and Wellness (PHW) has recently implemented new Outpatient Biopharmacy/Buy and Bill forms that providers can use for J-code or medical benefit pharmacy requests. This program is consistent with industry-wide efforts . Refer to NIA website (www.radmd.com) or call NIA at 800-642 . Contact NIA online or by telephone. NIA - Fidelis Care Physical Medicine Provider Webinar September 2021 Invite. Authorization requests may be submitted by fax, phone or secure web portal and should include all necessary clinical information. Sunshine Health has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology and cardiac imaging benefit management. PAF Artificial Cervical Disc Replacement A A National Imaging Associates (NIA) conducts utilization management review. The Trillium Prior Authorization form must be completed in its entirety and include sufficient . Only non-emergent procedures performed in an outpatient setting require . MHS has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. NIA Call Center will be available to submit requests for prior authorization for dates of service March 1, 2019, and beyond. The prior authorization component of Highmark Delaware's Radiology Management Program will require all physicians and clinical practitioners to obtain authorizations from National Imaging Associates, Inc. (NIA) when ordering select non-emergent, high-tech outpatient radiology services for Highmark Delaware members. Please note: The ordering physician is responsible for obtaining authorization prior to rendering the above-listed services. This program is consistent with industry-wide efforts to . The requirement applies when services are performed in an outpatient or office site of care. SERVICE HMO and In-Network POS PPO and Out of . Spine services. We work with National Imaging Associates (NIA) Magellan Healthcare . This program is consistent with industry-wide efforts to ensure clinically appropriate . All other visits and CPT codes following the four (4) visits will require authorization through NIA prior to services being rendered and billed. Fidelis Care has engaged National Imaging Associates, Inc., a Magellan Healthcare Company, to implement a new prior authorization program to manage outpatient (office and hospital) habilitative and rehabilitative physical medicine services, including services rendered in the home, effective on October . RadMD is a user-friendly, real-time tool offered by Magellan Healthcare that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Manuals, Forms and Resources. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Prior authorization may be required for outpatient radiology procedures. Effective April 1, 2022, the electronic prior authorization (ePA) form will no longer be an acceptable form of submission.Prior authorizations should be submitted through the new provider portal or via fax.. Prior authorization self-service is situate at RadMD To get. If you have any questions regarding this new prior authorization program, please contact the Fidelis Care Provider Call Center at 1-888-FIDELIS (1-888-343-3547). Network Providers will be able to request prior authorization via the Internet ( www.RadMD.com) or by calling: 1-800-424-4921 - PA Health and Wellness (Community Health Choices/Medicaid) 1-866-642-9705 - Allwell from PA Health and Wellness (MAPD/D-SNP) 1-866-500-7750 - Ambetter from PA Health and Wellness (Exchange) Ambetter from PA . Cigna/CareLink High-Tech Imaging Program. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Online: www.radmd.com. confirm that prior authorization has been requested and approved prior to the service(s) being performed. Please note the following: The ordering physician must obtain authorization before rendering the previously listed services. Use our tool to see if a pre-authorization is needed. The Prior Authorization component of Highmark's Radiology Management Program will require all physicians and clinical practitioners to obtain authorization when ordering selected outpatient, non-emergency, diagnostic imaging procedures for certain Highmark patients (This authorization requirement doesn't apply to emergency room or inpatient . To obtain and verify authorizations: ordering providers are required to call Cigna at 800.244.6224 prior to scheduling high-tech imaging services. For any questions or additional information, please contact NIA directly by email at RadMDSupport@MagellanHealth.com or by calling toll-free at 1-800-327-0641. This may vary based on the medication and its dosing schedule. NIA - Fidelis Care Physical Medicine Provider Webinar September 2021 Invite. Letter via postal mail to: National Imaging Associates, Inc. Attn: Appeals Department. Standard prior authorization requests should be submitted for medical necessity review at least five (5) business days before the scheduled service delivery date or as soon as the need for service is identified. National Imaging Associates (NIA) The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Cardiac or pulmonary rehabilitation. Chiropractic manipulative treatment for members over age of 18 (only codes 98940, 98941 and 98943). Terms of Use; Disclaimer; Privacy Policy Medicare Part D Medications. Prior authorization is required for the following outpatient radiology procedures: Providers rendering the above services should . Commercial Pre-Auth. This new form will ensure that PHW clinical reviewers have all the necessary information to complete your Biopharmacy Prior Authorization. An authorization number will be faxed to the provider upon approval. Telephone: 800-642-7543. Clinical guidelines can be found by visiting the NIA website at www.RadMD.com. Trillium Community Health Plan has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Forms. Care1st and WellCare has entered into an agreement with National Imaging Associates, Inc. (NIA)1, to implement a radiology benefit management program. Federal Employee Program. Authorization requests and status information can be obtained by calling the NIA telephone call center. Aetna has selected National Imaging Associates Inc NIA to provide utilization. Peach State Health Plan has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. NIA's Prior Authorization Program Effective July 1, 2019, the NIA Call Center will be available beginning July 1, 2019 for prior authorization for dates of service July 1, 2019 and beyond. AmeriHealth Caritas Pennsylvania's radiology benefits vendor, National Imaging Associates, Inc. (NIA), provides utilization management review and authorization for non-emergent, advanced, outpatient imaging procedures. Submit online at National Imaging Associates or call 1-800-642-7820. For a list of procedure codes subject to prior authorization by NIA, refer to the High-Tech Imaging and Cardiac Program Prior Authorization Code Matrix. Notice of Pregnancy NOP (PDF) for provider use. To obtain authorization, the provider should go to www.RadMD.com, or through the NIA dedicated toll-free phone number for Medicare 1-800-424-5388.; Providers rendering the services previously listed should verify that the necessary authorization has been obtained by . P.O. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. The website also provides additional information about NIA and its services. Authorization status for a provider's patients can also be checked online at the NIA website. For the best experience, please use the Pre-Auth tool in Chrome, Firefox, or Internet Explorer 10 and above. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. For both outpatient . NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities. Prior Authorization is not needed for Pregnancy related care, however notification is required. Authorization status and approved transaction numbers are also available to servicing providers through HPHConnect and NEHEN. To submit your request online, go to www.RadMD.com . Status and transaction numbers can be accessed through NIA's website at www.radmd.com. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure . 8/5/2019 • Posted by Provider Relations. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities. Any services rendered on and after March 1, 2019, will require prior authorization. Western Sky Community Care has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. You may fax the OB Prior Authorization form to the CM department at (202) 821-1098. eviCore helps to ensure our members receive appropriate radiology/imaging services, provides clinical consultation to our participating healthcare professionals and assists in the scheduling of . The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure . Physical Health Forms. Providers can also submit prior authorization telephonically at 1-800-642-7554 or through fax at 1-800-784-6864. Prior Authorization Updates up to May 2021. Review requests for services are performed by National Imaging Associates. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Health Net has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. This program is consistent with industry-wide efforts to ensure . The program includes management of prior authorization. National Imaging Association (NIA) manages prior authorization for MRI, PET, CT scans, nuclear cardiology, and radiation oncology procedures. This program is consistent with industry-wide efforts . Pre-Auth Check. Arkansas Health & Wellness has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Your doctor will receive an expiration notification by mail or fax at least 60 days before the . Box 1495. This program is consistent with industry-wide efforts to . YouthCare has contracted with National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management. Please contact National Imaging Associates (NIA) prior to or within 5 business days of rendering services. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Senior Products. If an authorization is needed, you can access our login to submit online. Security - Safely and securely transmit documentation to NIA and can ensure that all case-specific clinical information has been received. Phone: (888) NIA-BLUE (642-2583) National Imaging Associates (NIA) Orthopedic & Spinal Procedures (Turning Point) Pharmacy. ; Providers rendering the services listed in this letter should verify that the necessary authorization has been . The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. Emergency Room and Post Stabilization Services Never Require Prior Authorization California Health & Wellness's Medical Management department hours of operation are 8 a.m. - 5 p.m . Members of the Federal Employee Blue Cross/Blue Shield Service Benefit Plan (FEP) are subject to different prior authorization requirements.

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