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NIA Cardiac Expansion: Effective 01/01/2023

July 29, 2022

National Imaging Associates, Inc. (NIA) provides utilization management services for non-emergent, advanced diagnostic imaging services for Wellcare of South Carolina. In the interest of streamlining authorization processes and improving member outcomes, Wellcare has expanded its partnership with NIA. In addition to the procedures that currently require prior authorization through NIA, certain cardiac-related procedures will also require prior authorization beginning January 1, 2023. Providers may begin contacting NIA on January 1, 2023 to seek prior authorization for procedures scheduled on or after January 1, 2023.

Prior authorization through NIA is currently required for these outpatient advanced diagnostic imaging procedures:

  • CT/CTA
  • CCTA
  • PET Scan
  • MUGA Scan
  • Myocardial Perfusion Imaging (MPI)
  • Stress Echocardiography
  • Transthoracic Echocardiography (TTE)
  • Transesophageal Echocardiography (TEE)
  • Physical Medicine (Physical, Occupational and Speech Therapy)

Effective October 1, 2022, these cardiac-related procedures will also require prior authorization:

  • Left Heart Catheterization
  • Cardiac Implantable Devices (defibrillator, pacemaker)

Program Components

  • Evidence-based clinical guidelines and proprietary algorithms to support clinically appropriate options for each member.
  • Clinical reviews will be conducted by NIA board-certified internists with specialized cardiac training and board-certified cardiologists related to elective cardiac diagnostic imaging when peer-to-peer review is required.

We are confident this program will have a positive impact on the quality of care rendered to your members, and we look forward to working with you to deliver positive outcomes to our community. We would be happy to discuss the program further. Should you have questions, please contact Wellcare at 1-866-433-6041.


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Y0020_WCM_87476E Last Updated On: 7/29/2022
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