National Imaging Associates, Inc. (NIA) Radiation Oncology/ Medical Specialty Solutions Authorization Program Beginning October 1, 2021
8/27/2021
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Posted by Provider Relations
Beginning October 1, 2021, Fidelis Care is pleased to announce our expanded partnership with National Imaging Associates, Inc. (NIA) to provide utilization management for Radiation Oncology services and non-emergent, radiology outpatient Medical Specialty Solutions procedures for Fidelis Care members with Medicare, Medicaid, and Qualified Health plans. This program is consistent with industry-wide efforts ensuring that these services provided to our members are consistent with nationally recognized clinical guidelines.
Effective October 1, 2021 radiology services that required prior authorization through eviCore healthcare, will be managed by NIA. Authorizations rendered by eviCore for dates of service prior to 10/1/2021 will remain in effect post migration to NIA. It is not necessary to request these services again.
NIA will begin the management of radiation therapy treatment modalities, image guidance (IGRT), port film, and Radiology Medical Specialty Solution procedures performed in an outpatient setting. Providers may begin contacting NIA on September 20, 2021 to seek prior authorization for procedures scheduled on or after October 1, 2021. This correspondence serves as notice under your Fidelis Care Provider Agreement of changes to the program.
Prior authorization will be required for the following treatment modalities, the number of treatments/fractions for the course of treatments, and Medical Specialty Solution procedures
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Radiation Oncology Services
- Low-dose-rate (LDR) Brachytherapy
- High-dose-rate (HDR) Brachytherapy
- Electronic Brachytherapy
- Two-dimensional Conventional Radiation Therapy (2D)
- Three-dimensional Conformal Radiation Therapy (3D-CRT)
- Intensity Modulated Radiation Therapy (IMRT)
- Stereotactic Radiosurgery (SRS)
- Stereotactic Body Radiation Therapy (SBRT)
- Proton Beam Radiation Therapy (PBT)
- Intra-Operative Radiation Therapy (IORT)
- Neutron Beam Therapy
- Hyperthermia
- Image Guidance Radiations Therapy (IGRT)and Port Films
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Radiology Medical Specialty Solution Services
- CT/CTA
- CCTA
- MRI/MRA
- PET Scan
- Myocardial Perfusion Imaging
- MUGA Scan
- Stress Echocardiography
- Echocardiography
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* A full list of CPT codes can be found at https://www.fideliscare.org/Provider/Submit-Authorization-Requests
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 create a new Provider portal account, go to www.RadMD.com click the New User button and submit a RadMD Application for a New Account
Your RadMD login information should not be shared.
*The NIA Call Center and www.RadMD.com will be available beginning September 20, 2021, for prior authorization for dates of service October 1, 2021 and beyond.
National Imaging Associates Provider Notice
NIA will be conducting provider educational seminars on Radiation Oncology/ Medical Specialty Solutions services. Please follow this link for additional information and registration details:
NIA - Fidelis Care Radiation Oncology Provider Webinar September 2021 Invite
- Tuesday, September 14, 2021 at 8 AM EST
- Wednesday, September 22, 2021 at 12 PM EST
- Thursday, September 23, 2021 at 8 AM EST
- Tuesday, September 28, 2021 at 12 PM EST
NIA - Fidelis Care Advanced Imaging Cardiac Provider Webinar September 2021 Invite
- Wednesday, September 15, 2021 at 8 AM EST
- Monday, September 20, 2021 at 12 PM EST
- Tuesday, September 21, 2021 at 8 AM EST
- Wednesday, September 29, 2021 at 12 PM EST
Clinical guidelines can be found by visiting the NIA website at www.RadMD.com
If you have any questions regarding this new prior authorization program, please contact the Fidelis Care Provider Call Center at 1-888-FIDELIS (1-888-343-3547).
* A full list of CPT codes can be found at https://www.fideliscare.org/Provider/Submit-Authorization-Requests