Ambetter from Western Sky Community Care
Welcome to the Ambetter from Western Sky Community Care 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, Gina Braswell.
Advanced Imaging Program
- Utilization Review Matrix-2022 +0722T & +0724T will be effective 10/01/2022
- Frequently Asked Questions
- Quick Reference Guide
- Provider Education Presentation
- Pediatric Imaging Tip Sheet
- Prior Authorization Checklist
- Cardiac Utilization Review Matrix-2022
- Cardiac Frequently Asked Questions
- Cardiac Quick Reference Guide
- Cardiac Provider Education Presentation
- Cardiac Tip Sheet
- Cardiac Tip Sheet for MPI vs SE
- Cardiac Tip Sheet for TTE
- Cardac Tip Sheet for Echocardiogram
- Cardiac Tip Sheet for MPI
- Cardiac Checklist
Physical Medicine Program
- Physical Medicine Frequently Asked Questions
- Physical Medicine Quick Reference Guide
- Physical Medicine Provider Education Presentation
- Physical Medicine Checklist
- Physical Medicine Recording of Provider Training
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD is a user-friendly, real-time tool offered by Magellan Healthcare 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.
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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.
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
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).