Diagnostic Procedures

Health Net has an agreement 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.

NIA Agreement

NIA provides UM determinations for the following outpatient imaging procedures:

• 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)

Exceptions

Health Net retains responsibility for UM determinations for these services.

• Emergency room radiology services