Diagnostic Procedures
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Ancillary
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