Payment may be denied in accordance with plans policies and procedures and applicable law. Obtain a prior authorization from nia for an outpatient advanced imaging service for nonparticipating providers, join our network. In some cases, you may instead receive an nia tracking number not the same as an authorization number if your authorization request is not approved at the time of initial contact. Prior authorization check tool use our quick and easy online tool to see if a prior authorization is needed. National imaging associates nia western sky community care has contracted with national imaging associates inc. A prior authorization is not a guarantee of payment. Payment of claims is dependent on eligibility, covered benefits, provider contracts, correct coding and billing practices. Nia, an affiliate of magellan health services, for radiology benefit management the program includes management of nonemergent, hightech, outpatient radiology services through prior authorization. This program is consistent with industrywide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services. All providers will be required to obtain prior authorization for physical medicine services, which includes physical therapy, occupational therapy. Click to download provider manuals, tip sheets, important forms, and applications. Musculoskeletal services need to be verified by turning point all outofnetwork requests require prior authorization except emergency care, outofarea urgent care or outofarea dialysis. Kansas ambetter preauthorization sunflower health plan.
If your changes result from an outofstate move or a change of provider group, please use the form above instead. Your doctor must contact florida blues imaging coordinator, magellan healthcare national imaging associates nia, at 1866 3266302 or via. The authorization forms can be found in the provider resources section of this web site and should be faxed to 877 2126669, or submitted electronically via the secure provider portal. View and download this helpful quick reference guide on requesting preauthorization for. Arizona complete health would like to remind providers that all products medicaid, medicare, marketplace and commercial require prior authorization for high tech imaging services to be requested from national imaging associates nia niaradmd prior authorization submissions pdf. Providers can refer to the members health net identification id card to confirm product type. National imaging associates nia buckeye health plan has contracted with national imaging associates inc. Precertification bluechoice healthplan of south carolina. Fill out authorization to disclose personal health information.
Contact our provider relations department at 716 63282 or 18007365771, monday through friday from 8 a. Find out if you need a medicaid preauthorization with home state healths easy preauthorization check. Whether submitting imaging exam requests or checking the status of ordered exams, you will find radmd to be an efficient, easytonavigate resource. Abortion request authorization hfs form 2390 pdf sterilization consent form hfs form 2189 pdf hysterectomy information hfs form 1977 pdf hospice election form pdf master maintenance form pdf memberconnections referral form pdf memberconnections resolution form pdf disclosure of ownership and control interest statement form pdf. Prior authorization is required for greater than 5 visits per week. Please confirm the members plan and group before choosing from the list below. You may also reach your dedicated nia provider relations manager at that number. To get the medicare form you need, find the situation that applies to you. National imaging associates nia administered programs. Ordering care providers will complete the notificationprior authorization process online or over the phone. National imaging associates nia buckeye health plan. Providers should refer to the members evidence of coverage eoc or certificate of insurance coi to determine exclusions, limitations and benefit maximums that may apply to a particular procedure, medication, service, or supply. Get in touch with us national identification authority no.
Complex imaging, mra, mri, pet, and ct scans need to be verified by nia. Beginning january 1, 2015, some groups will require national imaging associates nia precertification for radiation oncology services when performed and billed in an outpatient or office location. Nonparticipating providers must submit prior authorization for all services. I want to make sure medicare can give my personal health information to someone other than me authorization to disclose personal health information form cms10106. Aperture the cvo services provider will assist with a providers credentialing process for superior healthplan. Nia manages nonemergent outpatient imagingradiology services through. Whether you are submitting imaging exam requests or checking the status of ordered exams, you will discover that nia is an efficient, easytouse resource. To submit a practitioner application to caqh, go to the caqh website. Whether submitting imaging exam requests or checking the status of ordered exams, you will find radmd to be an efficient, easy to navigate resource. Whether you are submitting imaging exam requests or checking the status of ordered exams, you will discover that nia is an efficient, easy to use resource. Your prescriber must request the prior authorization. National imaging associates nia mhs has contracted with national imaging associates inc.
A practitioner will need to register as a first time user to get started. Nia is an independent company that provides precertification services for certain imaging services on behalf of bluecross blueshield of south. Verbal agreements will, of course, suffice but it is better to be secure by filling out these forms. Use our tool to see if a preauthorization is needed. Our preauth check for iowa medicaid members is free and easy to use for our iowa total care network providers. You can also check the status of your authorization by contacting the phone number on the back of your id card. Coordinated care has contracted with national imaging associates nia for radiology benefit management. We may not cover the drug if you dont get approval. For specific details, please refer to the medicare provider manual. This is a page on the cms site that provides information about. If one is needed, you can submit the request online through our secure provider web portal. National imaging associates nia outpatient radiology.
For the best experience, please use the preauth tool in chrome, firefox, or internet explorer 10 and above. Complex imaging, mra, mri, pet and ct scans need to be verified by nia. Check to see if a preauthorization is necessary by using our preauth check tool. If you have a question or need more information about nias prior authorization program, you may contact the nia provider service line at.
Bilevel positive airway pressure bipap or continuous positive airway pressure cpap. National imaging associates nia louisiana healthcare. The authorization forms can be found in the provider resources section of this. This prior authorization list contains some services that require prior authorization only and is not intended to be a comprehensive list of covered services. For the best experience, please use the pre auth tool in chrome, firefox, or internet explorer 10 and above. Musculoskeletal services need to be verified by turning point.
Powered by nia national imaging associates, radmd offers providers and contracted health plans a wealth of powerful resources and information. Ordering physicians are required to request the preauthorization and. Payments are denied for procedures performed without the required authorization. Are services for hospice, dialysis, or are services being performed in the emergency department or urgent care center. The rendering facility or provider must verify that prior authorization was obtained prior to rendering the service.
Services for hospice, dialysis, or services being performed in the emergency department or. Nia that provides you with instant access to the hightech imaging authorization and supporting information you need, in an easily accessible internet format. 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. National imaging associates nia magnolia health has contracted with national imaging associates inc. Prior authorizations for musculoskeletal procedures should be verified by turningpoint. Our pre auth check for iowa medicaid members is free and easy to use for our iowa total care network providers. To submit prior authorization by fax, please send to 8778089362. Glossary of terms frequently used forms surprise bill law nurse chat newsroom blog. To verify, got to nias website or call nia at the planspecific phone numbers above. Are services being performed in the emergency department or urgent care center or for dialysis or family planning services billed with a contraceptive management diagnosis. An authorization form is needed when you just simply want to ask for a formal permission. Amerihealth caritas northeast will continue to perform prior authorization of coverage.
National imaging associates nia nh healthy families. All attempts are made to provide the most current information on the pre auth needed tool. Use our tool to see if a pre authorization is needed. For prior authorization complaintsappeals, please follow the instructions on the denial letter. Prior authorization provider resources nh healthy families. To obtain online authorization requests, view specific health plan clinical guidelines and provider education documents, please log on to radmd or if you are a new user, you may request a radmd user. Complex imaging, ct, pet, mra, mri, and high tech radiology procedures need to be authorized by nia all out of network requests require prior authorization except emergency care, outofarea urgent care or outofarea dialysis. Labs must register their tests to participate as part of the genetic and molecular lab. Complex imaging, mra, mri, pet, ct scans, pt, st, and ot need to be verified by nia. This prior authorization list contains some services that require prior authorization only and is not intended to be a. Authorization requests may be submitted by fax, phone or secure web portal and should include all necessary clinical information. National imaging associates nia silversummit healthplan.
The program includes management of nonemergent, hightech, outpatient. You have instant access to the imaging authorization and supporting information you need on this web site. All attempts are made to provide the most current information on the preauth needed tool. The following services do not require authorization through nia. Prior authorization is required for the following outpatient radiology procedures. National imaging associates nia provider resources iowa total. Authorization is required per 60day episode of care. For some drugs, your doctor must get approval from us before you fill your prescription.
If a subscriber or a covered family member is scheduled to receive a ct, mri, mra or pet scan from an outofnetwork provider in south carolina, it is the subscribers responsibility to make sure the provider calls for preauthorization. Refer to prior authorization contacts for submission information. If you are uncertain that prior authorization is needed, please submit a request for an accurate response. Oncologysupportive drugs need to be verified by new century health. The nia authorization number consists of eight or nine alphanumeric characters. Radmd for ordering and imaging providers radmd makes things easyfor you radmd is a userfriendly, realtime tool offered by national imaging associates, inc. Call nia for authorization18882031423 subscriber insurance holder and patient information. Ordering physicians are required to request the preauthorization and approval through.
If an authorization is needed, you can access our login to submit online. For specific details, please refer to the provider manual. Nia, an affiliate of magellan health services, for radiology benefit management. Nia call center will be available to submit requests for prior authorization for. This program replaces healthhelp for prior authorization of. Nia is an independent company that handles preauthorization for certain imaging services on behalf of bluecross. Radmd for ordering and imaging provider pdf opens a new window. If an authorization is needed, you can log in to your account to submit one online or fill out the appropriate fax form on the provider manuals and forms page. See our prior authorization list, which will be posted soon, or use our prior authorization prescreen tool.
Nevada medicaid preauthorization form silversummit healthplan. Credentialing documents are submitted to aperture through caqh or availity. Durable medical equipment dme including but not limited to. Cbas services with 15 visits per week require notification only. To change your phone or fax number, email address or practice address, use the link below. The program includes management of nonemergent, hightech, outpatient radiology services through prior authorization. Services requiring prior authorization oregonwashington. For part d prior authorization forms, please see the medicare section.
883 1198 517 648 1195 1022 1383 154 1387 906 992 1356 415 1209 1182 56 1322 686 1439 167 732 85 459 216 976 600 1435 1062 300 114 969 871 20 758 649 367 744 145 1137 1354 692 873