Ambetter from Sunshine Health
Welcome to the Ambetter from Sunshine Health Health Plan page. Here you can download policies and procedures specific to both ordering and rendering providers. These include quick reference guides and information designed to assist you in using RadMD to request and check the status of prior authorizations.
If you have any questions about our programs, please contact your dedicated NIA Provider Relations Manager, Andrew Dietz.
Effective 1/20/2023, National Imaging Associates, Inc. is now a subsidiary of Evolent Health. Evolent Health and its affiliates and subsidiaries collectively referred to as “Evolent.”
Advanced Imaging Program
- Frequently Asked Questions
- Quick Reference Guide
- Provider Education Presentation
- Peer-to-Peer Process
- Utilization Review Matrix-2023
For access to our Advanced Imaging Program tip sheets/checklists, click here.
Physical Medicine Program
- Physical Medicine Provider Education Presentation
- Physical Medicine Quick Reference Guide
- Physical Medicine Frequently Asked Questions
For access to our Physical Medicine Program tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
RadMD is a user-friendly, real-time tool offered by NIA that provides ordering and rendering providers with instant access to prior authorization requests for specialty procedures. Whether submitting exam requests or checking the status of prior authorization requests, providers will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by program:
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.
2013 Jimmo vs Sebelius Settlement Agreement
Click here for information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
Clinical Guidelines
- Clinical Guidelines
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Refer to the Utilization Review Matrix document to view specific codes managed by NIA
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).