Radiology Management Program

Effective 12/31/2018, Highmark ended the Radiology Management Program supported by NIA.  NIA will continue to process appeals for prior authorizations issued in 2018, and retro authorizations for service dates in 2018.  For new prior authorizations, and for appeals and retro authorizations for service dates in 2019 and beyond, please see links and guidance under the new Advanced Imaging and Cardiology Services Program.

Program Information
National Imaging Associates, Inc. (NIA), an affiliate of Magellan Health, Inc. provides utilization management services for non-emergent, high-tech outpatient radiology services rendered to members enrolled in Highmark West Virginia commercial health plans, including Super Blue Plus PPO, Super Blue Select Point of Service (POS), Steel, West Virginia Small Business Plan (WVSBP) and HHIC Freedom Blue Medicare Advantage Plan. The requirements will be waived for Mountain State's Traditional Indemnity product, Bluecard and the Federal Employee (FEP) program.

Clinical Guidelines
This link is designed to establish a pathway to clinical consensus on the use of a single or combination of Diagnostic Imaging examinations. At the link above you will need to select HIGHMARK WEST VIRGINIA from the "Please Select A Health Plan" dropdown box.

Last updated on 4/4/2019

 

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