National Imaging Associates (NIA)
Nebraska Total Care has contracted with National Imaging Associates (NIA), an affiliate of Magellan Health Services, for radiology and physical, ocupational, and speech therapy benefit management.
The radiology 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.
Nebraska Total 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
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.
Physical, occupational, and speech therapy services claims will be reviewed by NIA peer consultants to determine whether the services met/meet Nebraska Total Care Health Plan’s policy criteria for medically necessary and medically appropriate care. These determinations are based on a review of the objective, contemporaneous, clearly documented clinical records. These reviews help us determine whether such services (past, present, and future) are medically necessary and otherwise eligible for coverage.
NIA may request clinical documentation to support the medical necessity and appropriateness of the care. NIA will notify providers if records are needed. If records are determined to be necessary, Nebraska Total Care cannot adjudicate claims until the necessary information is received. If the documentation received fails to establish that care is/was medically necessary Nebraska Total Care Health Plan may deny payment for services and future related therapy services thereafter. If requested records are not received, claims will be denied due to lack of information.
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.