New Vendor for Medical Necessity Reviews for Advanced Imaging Services
Effective March 1, 2022, National Imaging Associates, Inc. (NIA) will be contracted by VHP to perform medical necessity reviews for advanced imaging services (such as MRI/MRA, CT/CTA, Nuclear Cardiology, PET) for VHP members.
The medical necessity criteria, used to review the imaging requests, are developed by NIA and are based on data, scientific evidence-based literature and are approved by VHP.
It is vitally important to have all of the necessary clinical information prior to the request in order to prevent a delay or adverse decision in the review.
Information to have ready includes:
- Facility for the study (in-network with VHP or par).
- Diagnosis code(s).
- CPT code of the study.
- Other imaging results.
- Clinical notes and/or reason for the study.
You may obtain NIA preauthorization via:
As a reminder, prior to the request have all the clinical information gathered in order to prevent any delay in the review. If NIA requests additional information please ensure it is sent within the time constraints of the review. This is extremely important in the continuity of care to our members and your patient.
On behalf of Vibra Health Plan, National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Healthcare, Inc. assists in the administration of radiology and radiation oncology benefits. NIA and Magellan Healthcare are independent companies.