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2022-03: Medicare - NIA to Manage Authorizations Procedures Effective July 1

Date: 04/26/22

To align our prior authorization process with industry best practices and streamline administrative processes for our providers and members, Wellcare by Allwell will expand our partnership with National Imaging Associates (NIA) to include Interventional Pain Management (IPM) and additional certain cardiac-related procedures effective July 1, 2022. Our shared goal is to help your patients get the care they need with less administrative burden for your practice.

Providers may begin contacting NIA on July 1, to seek prior authorization for procedures scheduled on or after July 1. Authorizations may be submitted online at www.RadMD.com or by phone at 1-866-326-6301.

Interventional Pain Management (IPM) Program Authorizations

This program includes prior authorization for non-emergent outpatient IPM procedures for Wellcare by Allwell members. Wellcare by Allwell will oversee the IPM program and continue to be responsible for claims adjudication and medical policies.

Effective July 1, 2022, prior authorization will be required through NIA for the following non-emergent outpatient IPM procedures:

  • Spinal Epidural Injections
  • Paravertebral Facet Joint Injections or Blocks
  • Paravertebral Facet Joint Denervation (Radiofrequency (RF) Neurolysis)
  • Sacroiliac Joint Injections

Authorizations for Additional Cardiac-Related Procedures

NIA currently provides utilization management services for non-emergent, advanced diagnostic imaging services for Wellcare by Allwell, including CT/CTA, MRI/MRA, PET Scan, Myocardial Perfusion Imaging (MPI), and CCTA.

Effective July 1, 2022, these cardiac-related procedures will also require authorization through NIA:

  • Left Heart Catheterization
  • Cardiac Implantable Devices (defibrillator, pacemaker)

Authorizations for Physical, Occupational, and speech therapy services

Effective July 1, 2022, NIA will provide utilization management for the following outpatient rehabilitative and habilitative physical medicine services:

  • Physical therapy services
  • Occupational therapy services
  • Speech therapy services

Even if an “Approved Authorization” has been obtained, providers will need to ensure that the member’s therapy benefit has not been exhausted prior to providing services by calling Wellcare by Allwell Provider Services at HMO 1-855-766-1572; HMO D-SNP 1-833-541-0767.

Thank you for the care you provide to your patients – our members – to improve their health and wellness. In the coming weeks, you will receive more information from NIA. This will include details about training. If you have any questions about these programs, please contact Wellcare by Allwell Provider Services at HMO 1-855-766-1572; HMO D-SNP 1-833-541-0767.