May 27, 2021
Beginning July 1, 2021, WellCare Health Insurance Company of Louisiana, Inc. is pleased to announce we are expanding our partnership with National Imaging Associates, Inc. (NIA) to provide utilization management for the following Medical Specialty Solutions Programs:
- Interventional Pain Management (IPM)
- Rehabilitative and Habilitative Physical Medicine
These programs include management of Medical Specialty Solutions services to include prior authorization for WellCare Health Insurance Company of Louisiana members. This decision is consistent with industry efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
Under terms of the agreement, WellCare Health Insurance Company of Louisiana will oversee NIA’s programs and continue to be responsible for claims adjudication. NIA will manage the services listed below through WellCare Health Insurance Company of Louisiana’s existing contractual relationships.
Based on a July 1, 2021, implementation, this correspondence serves as notice under your WellCare Health Insurance Company of Louisiana Provider Agreement of changes to these programs.
Prior authorization will be required for the following outpatient services:
Rehabilitative and Habilitative Physical Medicine Services
- The ordering physician must obtain authorization before rendering the previously listed services. To obtain authorization, the provider should go to www.RadMD.com, or through the NIA dedicated toll-free numbers for Medicare: 1-800-424-5388.
- Providers rendering the services previously listed should verify that the necessary authorization has been obtained by visiting www.RadMD.com, or by calling NIA at (Medicare)
1-800-424-5388. Failure to do so may result in nonpayment of your claim.
- Please keep in mind that providers must ensure the member’s therapy benefit has not been exhausted before providing services, even if an “Approved Authorization” has been obtained. This can be accomplished by calling WellCare Health Insurance Company of Louisiana at 1-877-389-9457.
- Emergency room and inpatient Medical Specialty Solutions services do not require authorization through NIA.