CareSource Marketplace Ohio
Welcome to CareSource Marketplace Ohio page. Here you can download policies and procedures specific to both ordering providers and imaging facilities. These include quick reference guides and FAQs. You can also view information designed to assist you in using the RadMD Website to obtain and check authorizations.
If you have any questions about the NIA Program, please contact your dedicated NIA Provider Relations Manager, Meghan Murphy.
Update on COVID-19
Effective 1/1/18, in addition to the management of MR, CT and PET, prior authorization will be required for the following cardiac procedures for ONLY CareSource OH Exchange, Medicare, Medicare Advantage, ABD Adults and MAGI members as well as CareSource KY, WV and IN Exchange.
- Myocardial Perfusion Imaging (MPI)
- MUGA Scans
- Echocardiography (Transthoracic and Transesophageal Echocardiography)
- Stress Echocardiography
Note: The above cardiac procedures will NOT require prior authorization for Ohio CFC and ABD Kids and Indiana and Georgia Medicaid members.
Documents
- Frequently Asked Questions
- Prior Authorization Checklist
- Provider Education Presentation
- Quick Reference Guide for Ordering Providers
- Quick Reference Guide for Rendering Providers
- Tip Sheet for Ordering Advanced Imaging Studies
- CareSource Marketplace Ohio Utilization Review Matrix-2021
- Peer-to-Peer Process
RadMD Documents
RadMD is our user-friendly, real-time tool that provides you with instant access to the high-tech imaging authorization and supporting information you need. Whether submitting imaging exam requests or checking the status of a prior authorization request, you will find RadMD to be an efficient, easy-to-navigate resource.
Search for resources by solution below:
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.
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.