July 8, 2021
Dear Provider,
Thank you for your valued partnership.
In keeping with our commitment of promoting continuous quality improvement for services provided to WellCare of New Jersey (WellCare) members, WellCare has entered into an agreement with National Imaging Associates, Inc. (NIA)1, to implement 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's members. 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 WellCare and NIA, WellCare will oversee NIA's programs and continue to be responsible for claims adjudication. NIA will manage the services listed below through WellCare’s existing contractual relationships.
Based on an August 1, 2021 implementation, this correspondence serves as notice under your WellCare Provider Agreement of changes to these programs.
Prior authorization will be required for the following outpatient services:
| IPM Procedures | Habilitative Physical Medicine Services |
|---|---|
|
|
Please note the following:
- The ordering physician is responsible for obtaining authorization prior to rendering the above-listed services. To obtain authorization, the provider should go to the NIA website at www.RadMD.com, or through the NIA dedicated toll-free phone number 1-866-249-1585.
- Providers may begin contacting NIA on July 21, 2021 to seek prior authorization for procedures scheduled on or after August 1, 2021.
- Providers rendering the services listed above should verify that the necessary authorization has been obtained by visiting www.RadMD.com, or by calling NIA at 1-866-249-1585. Failure to do so may result in nonpayment of your claim.
- Please keep in mind you will need to ensure that the member's therapy benefit has not been exhausted prior to providing services, even if an "Approved Authorization" has been obtained. This can be accomplished by calling WellCare of New Jersey's Provider Services at (Medicaid) 1-888-453-2534 or (Medicare) 1-855-538-0454.
- Emergency room and inpatient Medical Specialty Solutions services do not require authorization.
We appreciate your support and look forward to your assistance in assuring that WellCare’s members receive these services delivered in a quality, clinically appropriate manner.
We will provide additional information as we get closer to the implementation date. Should you have questions at this time, please contact your WellCare Provider Services Department at (Medicaid) 1-888-453-2534 or (Medicare) 1-855-538-0454.
Sincerely,
WellCare Health Plans
