NIA Announcement - Radiology Benefit Management Program

Date: 12/16/20

In keeping with our commitment of promoting continuous quality improvement for services provided to Ambetter from Meridian (Ambetter) members, Ambetter has entered into an agreement with National Imaging Associates, Inc. (NIA) to implement a radiology benefit management program. This program includes management of non-emergent, advanced outpatient imaging services to include prior authorization of our members. This decision is consistent with industry-wide efforts to ensure clinically appropriate quality of care and manage the increasing utilization of these services.

Under terms of the agreement between Ambetter and NIA, Ambetter will oversee the NIA program and continue to be responsible for claims adjudication. NIA will manage the nonemergent outpatient imaging services listed below through Ambetter’s existing contractual relationships.

Based on a January 1, 2021 implementation, this correspondence serves as notice of changes to the program under your Ambetter from Meridian Provider Agreement.

Prior authorization will be required for the following outpatient imaging procedures:

• CT/CTA
• CCTA
• MRI/MRA
• PET Scan
• Myocardial Perfusion Imaging
• MUGA Scan
• Stress Echocardiography
• Echocardiography 

Please note the following:

• The ordering physician is responsible for obtaining authorization prior to rendering the above listed services. To obtain authorization, the provider should go to the NIA website or use the NIA’s dedicated toll-free phone number, 800-424-4926 
• Providers rendering the services listed above should verify that the necessary authorization has been obtained by visiting www.RadMD.com or by calling NIA at 800- 424-4926. Failure to do so may result in nonpayment of your claim 
• Emergency room, observation, and inpatient imaging procedures do not require authorization 

We appreciate your support and look forward to your assistance in ensuring that Ambetter members receive diagnostic imaging services delivered in a high-quality, clinically-appropriate manner.

We will provide additional information as we get closer to the implementation date. Should you have questions at this time, please contact Ambetter Provider Services at 833-993-2426.