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National Imaging Associates (NIA)

Radiology

Louisiana Healthcare Connections 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. This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Louisiana Healthcare Connections 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:

  • CT/CTA/CCTA
  • MRI/MRA
  • PET Scan

Key Provision:

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.

Go to the NIA website for more information.

Therapy Services (PT, OT, ST)

Effective March 1, 2019, physical medicine services (physical therapy, occupational therapy and speech therapy) will no longer be managed through a post-service review process for Louisiana Healthcare Connections.  Louisiana Healthcare Connections remains committed to ensuring that physical medicine services provided to our members are consistent with nationally recognized clinical guidelines.  Therefore, the utilization management of these services will be managed by National Imaging Associates, Inc. (NIA) through a prior authorization program.  All providers will be required to obtain prior authorization for Physical Medicine services. 

NIA Call Center will be available to submit requests for prior authorization for dates of service March 1, 2019, and beyond. Any services rendered on and after March 1, 2019, will require prior authorization.

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.  When requesting an authorization, please provide the name, address and TIN of the facility that will be used for billing the services.  Payments will be denied for services performed without a necessary prior authorization, and the member cannot be balance-billed for such services.

You will be able to upload requested records on the NIA website www.RadMD.com or through the NIA fax number at 1-800-784-6864.  Medical necessity reviews are based on clinical guidelines which are available on the NIA website.

For more information, please see our Louisiana Healthcare Connections Physical Medicine Prior Authorization Quick Reference Guide for Providers (https://www.louisianahealthconnect.com/content/dam/centene/louisiana-health-connect/pdfs/medicaid-provider/NIA_Physical_Medicine_QRG.pdf)