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National Imaging Associates, Inc. (NIA) Authorization Program Beginning October 1, 2019
8/5/2019 • Posted by Provider Relations

Fidelis Care has engaged National Imaging Associates, Inc., a Magellan Healthcare Company, to implement a new prior authorization program to manage outpatient (office and hospital) habilitative and rehabilitative physical medicine services, including services rendered in the home, effective on October 1, 2019*.

This program is consistent with industry-wide efforts to manage the increasing utilization of these services and to ensure quality of care.  All providers will be required to obtain prior authorization for physical medicine services, which includes physical therapy, occupational therapy, and speech therapy.
 
This program will include the following Fidelis Care health insurance products: 

•    Medicaid Managed Care (NYM)    
•    Child Health Plus(CHP)
•    HealthierLife (HARP)
•    Metal-level Products (qualified health plan)
•    Essential Plan (EP)

Submitting Prior Authorization Requests 
•    There are two preferred ways to submit prior authorization -- either through the NIA website at     
      www.RadMD.com** or by calling NIA at 1-800-424-4952**.
•    To get started, go to www.RadMD.com click the New User button and submit a RadMD Application for 
      New Account by selecting “Physical Medicine Practitioner.”  Your RadMD login information should not be
      shared.  

**The NIA Call Center and **www.RadMD.com will be available beginning September 23, 2019, for prior authorization for dates of service October 1, 2019 and beyond.

Further details regarding this new prior authorization program can be found by viewing the resource links below.

National Imaging Associates Provider Notice
Fidelis Care Physical Medicine Prior Authorization Quick Reference Guide for Providers
Frequently Asked Questions – Fidelis Care Physical Medicine Services Prior Authorization

Clinical guidelines can be found by visiting the NIA website at www.RadMD.com

Additional information and training dates for providers will be shared as they becomes available.

*Note:  This new prior authorization program is pending New York State approval.

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Each day, Fidelis Care's Utilization Management (UM) Department makes decisions on numerous health insurance claims. These decisions are based only on appropriateness of care and the existence of coverage. 

Fidelis Care does not reward practitioners or other individuals for issuing denials of coverage, and does not offer financial incentives to UM staff that would encourage decisions that result in underutilization of services. 

Fidelis Care is committed to ensuring that members have the care and services they need. 

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