RadMD is a user-friendly, real-time alternative or supplement to our call center. Our system provides instant access to much of the prior authorization information that our call center staff provides. Primarily designed for Imaging Facilities, Hospitals and Health Plans, logging on to RadMD can provide up-to-the-hour information on a member's authorization, including date called, date approved ...
These medical necessity criteria were developed by National Imaging Associates, Inc. (NIA) for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, cardiology, and other specialty groups. NIAs guidelines are reviewed ...
What information does NIA require before a medical necessity review can be initiated for prior authorization determination? Radiation Oncologist should have all of the following informati n available before logging on to NIA’s website, https://www.RadMD.com or by When should requests for medical necessity review be submitted?
Preamble NIA is committed to the philosophy of supporting safe and effective treatment for patients. The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging. These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient’s unique circumstances. In all cases, clinical judgment consistent ...
The following non-emergent, outpatient, Medical Specialty Solutions services require prior authorization through NIA effective : CT/CTA MRI/MRA PET Scan CCTA MUGA Scan Myocardial Perfusion Imaging (MPI) Emergency room, observation and inpatient procedures do not require prior authorization from NIA. If an urgent/emergent clinical situation exists outside ...
National Imaging Associates Inc. (NIA) Medical Specialty Solutions Frequently Asked Questions (FAQ’s) Blue Cross Blue Shield of South Carolina Providers
The following non-emergent, outpatient, Medical Specialty Solutions services require prior authorization through NIA: Emergency room/urgent care facility, observation and inpatient procedures do not require prior authorization from NIA. Authorizations through NIA are required for inpatient Musculoskeletal Surgeries and Sleep Assessments. If an urgent/emergent clinical situation exists outside ...