Ambetter of Tennessee
Welcome to the Ambetter of Tennessee 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, Debbie Patterson.
Effective 1/20/2023, National Imaging Associates, Inc. is now a subsidiary of Evolent Health.
Advanced Imaging Program
- Frequently Asked Questions
- Quick Reference Guide
- Utilization Review Matrix-2023
- Prior Authorization Checklist
- Provider Education Presentation
- Peer-to-Peer Process
Physical Medicine Program
- Physical Medicine Frequently Asked Questions
- Physical Medicine Provider Education Presentation
- Physical Medicine Quick Reference Guide
- Physical Medicine Checklist
- Physical Medicine Recording of Provider Training
Musculoskeletal Surgery (MSK) and Interventional Pain Management (IPM) Programs - Effective 6/1/2023
- Provider Education Presentation
- MSK Frequently Asked Questions
- MSK Quick Reference Guide
- Spine Surgery Checklist
- Hip, Knee, Shoulder Surgery Checklist
- Shoulder Arthroplasty Clinical Tip Sheet
- Shoulder Arthroscopy Clinical Tip Sheet
- Knee Arthroscopy Clinical Tip Sheet
- Hip & Knee Arthroplasty Clinical Tip Sheet
- IPM Frequently Asked Questions
- IPM Checklist
- Conservative Care - Patient Info Sheet
- Guide to Home Exercises
- IPM Utilization Review Matrix
- MSK (Spine) Utilization Review Matrix
- MSK (Hip, Knee, Shoulder) Utilization Review Matrix
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
RadMD Documents
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.
Search for resources by program:
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
- 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).