August 27, 2021
WellCare Health Plans is pleased to announce that beginning October 1, 2021, we are expanding our partnership with National Imaging Associates, Inc. (NIA)1, 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 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 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 October 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 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 phone number 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 (Medicare) at 1-800-424-5388. Failure to do so may result in nonpayment of your claim.
For Physical Medicine:
- Please keep in mind that providers 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 at 1-833-444-9088.
For Both Programs:
- IMP and Physical Medicaid services performed in an emergency room or inpatient setting do not require authorization through NIA.
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.
1National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare, Inc.