Aetna
Welcome to the Aetna page. Here you can access useful materials about the program.
Aetna has selected National Imaging Associates, Inc. (NIA) to provide utilization management for physical medicine. Beginning September 1, 2018, for Delaware, New York, Pennsylvania and West Virginia, providers must request prior authorization for physical therapy, occupational therapy and chiropractic services through NIA at RadMD.com.
Refer to the state-specific CPT Matrix document below to view specific codes managed by NIA.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager:
- Delaware: Charmaine Everett
- New Jersey: Seth Cohen
- New York: Seth Cohen
- Pennsylvania: Seth Cohen
- West Virginia: Seth Cohen
News and Updates
- Updated Physical Medicine Quick Start Guide - New
- Recording of Aetna Physical Medicine Update Provider Training
- Aetna Total Number of Units Provider Update
- Aetna Total Number of Units FAQ Update
- Aetna Total Number of Units Provider PowerPoint Update
- New Prior Authorization Requirement
- Peer-to-Peer Process
- Change to How Partial Approvals are Displayed on RadMD - New
Delaware
- DE Physical Medicine Utilization Review Matrix-2022
- DE Physical Medicine Updated QRG
- DE Physical Medicine Updated FAQ
- DE Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
- Recording of Aetna Webinar Training
New Jersey
- NJ Physical Medicine Utilization Review Matrix-2022
- NJ Physical Medicine Updated QRG
- NJ Physical Medicine Updated FAQ
- NJ Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
New York
- NY Physical Medicine Utilization Review Matriz-2022
- NY Physical Medicine Updated QRG
- NY Physical Medicine Updated FAQ
- NY Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
- Recording of Aetna Webinar Training
Western New York
- WNY Physical Medicine Utilization Review Matriz-2022
- Western NY Physical Medicine Updated QRG
- Western NY Physical Medicine Updated FAQ
- Western NY Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
Pennsylvania
- PA Physical Medicine Utilization Review Matrix-2022
- PA Physical Medicine Updated QRG
- PA Physical Medicine Updated FAQ
- PA Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
- Recording of Aetna Webinar Training
West Virginia
- WV Physical Medicine Utilization Review Matriz-2022
- WV Physical Medicine Updated QRG
- WV Physical Medicine Updated FAQ
- WV Physical Medicine Updated Provider Education PowerPoint
- Physical Medicine Updated Tip Sheet/Checklist - New
- RadMD Requesting Additional Physical Medicine Units
- Recording of Aetna Physical Medicine Update Provider Training
- Recording of Aetna Webinar Training
Documents
RadMD User References
- Ordering Provider Access
- RadMD Quick Start Guide
- RadMD Upload Feature
- RadMD Physical Medicine Requesting Additional Units
- RadMD View Exam with Tracking Number
- RadMD Upload without Login
Recorded General Trainings
We have a series of training videos that discuss the components of requesting a prior authorization request. Click here to access these videos.
Recorded RadMD Demos
Need additional help using RadMD? Click here to access a series of RadMD demos that demonstrate how to properly submit a prior authorization request.
Physical Medicine Guidelines
Refer to the state-specific CPT Matrix document above to view specific codes managed by NIA.
MCG Guidelines®
- Magellan adopted the use of MCG Guidelines® for its Physical Medicine product. More information available here: /media/871888/instructions-for-accessing-mcg-guidelines-ambcare.pdf
Clinical Training Modules
We have a series of clinical training modules that will help you avoid delays and ensure that you have the right information before submitting your prior authorization request. Click here to access them.
Update on COVID-19
Click here to view our recommendations on the use of CT to detect Coronavirus (COVID-19).