NIA - Prior Authorization
Health Net is partnering with National Imaging Associates, Inc. (NIA) to provide utilization management (UM) services, including prior authorization determinations for certain advanced and cardiac imaging for fee-for-service (FFS) members.
The following outpatient procedures require prior authorization, with the exception of emergency room radiology services:
- Advanced imaging:
- Computed tomography (CT)/computed tomography angiography (CTA)
- Magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA)
- Positron emission tomography (PET) scan
- Cardiac imaging:
- Coronary computed tomography angiography (CCTA)
- Myocardial perfusion imaging (MPI)
- Multigated acquisition (Muga) scan
- Stress echocardiography
- Transthoracic echocardiography (TTE)
- Transesophageal echocardiography (TEE)
Submitting Prior Authorization Requests
Prior authorization requests must be submitted to NIA online or by telephone as follows. NIA does not accept fax submissions.
- Online - Post-log in at www.RadMD.com, 24 hours a day, seven days a week, except when maintenance is performed once every other week after business hours.
- Telephone, available Monday through Friday, from 8:00 a.m. to 8:00 p.m. at:
Expedited authorization requests may only be submitted by telephone.
To expedite the request process, providers must have the following information ready before logging in to the NIA website or calling (*denotes required information):
- Name and office telephone number of ordering provider.*
- Member name and identification (ID) number.*
- Requested examination.*
- Name of provider office or facility where the service will be performed.*
- Anticipated date of service (if known).
- Details justifying the examination.*
- Symptoms and their duration.
- Physical exam findings, including findings applicable to the requested services, conservative treatment the member has already completed (such as physical therapy, chiropractic or osteopathic manipulation, hot pads, massage, ice packs, and medication).
- Results and/or reports of preliminary procedures already completed (such as X-rays, CTs, lab work, ultrasound, scoped procedures, referrals to specialist, and specialist evaluation).
- Reason the study is being requested (such as further evaluation, rule out a disorder).
The following information may also be requested:
- Clinical notes
- Reports of previous procedures
- Specialist reports/evaluation