Fidelis Care Musculoskeletal Management Program Transitioning to Evolent (NIA) Effective January 1, 2024
11/29/2023
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Posted by Provider Relations
In an effort to continue promotion of quality improvement for services provided to Fidelis Care members, effective January 1, 2024, Fidelis Care is expanding its existing partnership with National Imaging Associates, Inc. (NIA)1 to provide the management and prior authorization of non-emergent Musculoskeletal (MSK) procedures including: inpatient and outpatient hip, knee, shoulder, lumbar and cervical spine surgeries. This decision is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
Under terms of the agreement between Fidelis Care and NIA, Fidelis Care will oversee the MSK program and continue to be responsible for claims adjudication and medical policies. NIA will manage non-emergent inpatient and outpatient MSK surgeries through the existing contractual relationships with Fidelis Care. Providers may begin contacting NIA on January 1, 2024 to seek prior authorization for procedures scheduled on or after January 1, 2024. Please note that this change is pending final state approval.
Fidelis Care and NIA welcome providers to attend an upcoming provider education webinar on the NIA MSK Management Program prior authorization process. There will be several one-hour long webinar sessions that will take place on the following dates. You will only need to attend one of these educational sessions.
- Wednesday, December 6, 2023 12 PM ET
Register at the following address: https://zoom.us/j/98873282869?pwd=dXI4N2V4SFRZeVlXZVJBM1VsVXh0Zz09
- Thursday, December 14, 2023 8 AM ET
Register at the following address: https://zoom.us/j/99526310637?pwd=VjRTU0ZpNUNKRllrYlVBcExKSUtWQT09
- Tuesday, December 19, 2023 12 PM ET
Register at the following address: https://zoom.us/j/92033337955?pwd=a25nelcxa081a1JkZVdPY1NMMFZFZz09
- Friday, January 5, 2024 12 PM ET
Register at the following address: https://zoom.us/j/95048125341?pwd=eUc5cCtmTDBjYTJ1bS9DREtyKzFLZz09
It is recommended but not mandatory that you RSVP at least one week prior to the training that you plan to attend by registering for one of the education sessions above. You can either click on the registration link or type the URL address into your browser to register.
You will receive a registration confirmation email from NIA for the Webinar session you selected. It is recommended that computer access is utilized, if possible, to view educational documents during the webinar. To access the webinar by computer, please click on the link for the session you would like to attend or type the URL address into your browser.
Fidelis Care and NIA look forward to working with you to ensure that Fidelis Care members receive MSK management procedures delivered in a quality, clinically appropriate fashion.
All Fidelis Care approved training/education materials are posted on the NIA website, https://www.RadMD.com. For new users to access these web-based documents, a RadMD account ID and password must be created.
To get started, simply go to https://www.RadMD.com, click the New User button, select “Physician’s office that orders procedures” and submit a “RadMD Application for New Account.” Once the application has been processed and a password link delivered by NIA via e-mail, you will then be invited to create a new password. Links to the approved training/education documents will be among the RadMD Menu Options available after logging into the website.
1Effective 1/20/2023, National Imaging Associates, Inc. is now a subsidiary of Evolent Health. Evolent Health and its affiliates and subsidiaries collectively referred to as “Evolent.”