National Imaging Associates (NIA)
Coordinated Care has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management, cardiac solutions and interventional pain management.
For policies and procedures specific to both ordering providers and imaging facilities, quick reference guides and FAQs, visit the Coordinated Care page on NIA's web site.
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 clinically appropriate quality of care and to manage the increasing utilization of these services.
Coordinated Care oversees the NIA program and is responsible for claims adjudication. NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities.
Prior authorization is required for the following outpatient radiology procedures:
- PET Scan
NIA also reviews cardiac imaging studies to promote health care quality for patients with possible cardiac disease. Under this program, prior authorization is required for certain cardiac studies to determine if the cardiac test or procedure is the most appropriate next step in a patient’s diagnosis or treatment, and to recommend an alternate approach when indicated. By supporting the most efficient diagnosis and management of cardiac disease, NIA addresses unnecessary procedures and promotes the least invasive, most medically appropriate approach.
NIA Magellan has developed proprietary utilization management guidelines for these cardiac modalities. These consensus-based guidelines draw on current literature, American College of Cardiology (ACC) appropriateness criteria, recommendations from the American Heart Association, and input from our Cardiac Advisory Board and other experts. NIA’s guidelines are transparent and available throughout their programs. NIA also includes references to the Choosing Wisely campaign by the American Board of Internal Medicine (ABIM) Foundation, which provides specialty society considerations for the selection of appropriate tests.
NIA manages prior authorization for the following cardiac procedures:
- Myocardial Perfusion Imaging (MPI)
- MUGA Scan
- Stress Echocardiography
- Left Heart Catherization
- Implantable Devices
Interventional Pain Management
NIA manages non-emergent outpatient prior authorizations for Interventional Pain Management (IPM) procedures. It is the responsibility of the ordering physician to obtain authorization for all IPM procedures outlined below. Outpatient IPM procedures requiring prior authorization include:
- Spinal Epidural Injections
- Paravertebral Facet Joint Injections or Blocks
- Paravertebral Facet Joint Denervation (Radiofrequency Neurolysis)
- Sacroiliac Joint Injections
Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim. A separate prior authorization number is required for each procedure ordered.
Prior authorization is not required through NIA for services performed in the emergency department, on an inpatient basis or in conjunction with a surgery. Prior authorization and/or notification of admission in those instances is required through the health plan.
To obtain authorization through NIA or for more information, visit the RadMD.com.