National Imaging Associates, a Magellan Health Services Company
Welcome to RADMD

Health Plans

Harvard Pilgrim Health Care

Welcome to the Harvard Pilgrim HealthCare 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 Web site to obtain and check authorizations.

For dates of service beginning June 24, 2019, the following cardiac procedures will require prior authorization for our commercial members:  Cardiac Resynchronization Therapy (CRT), Implantable Cardioverter Defibrillator (ICD), Pacemaker Insertion, Transthoracic Echocardiography (TTE), Transesophageal Echocardiography (TEE), Stress Echocardiography, Heart Catheterization.  (These procedures began requiring prior authorization for our Medicare Advantage members on Jan. 1, 2019).

  

Massachusetts Imaging Prior Authorization Form

http://www1.radmd.com/authorizations/state-authorization-requirements-and-clinical-criteria.aspx

Cardiac Solutions

 

 

Musculoskeletal Management Program

Please note that CPT Codes 22800-22819 used for reconstructive spinal deformity surgery and the associated instrumentation do not require NIA/HPHC’s prior authorization. NIA will monitor the use of these CTP codes, but prior authorization is not currently required. As long as, the deformity surgery coded does not include CPT codes on NIA/HPHC’s prior authorization list, the case will process in HPHC claims accordingly.

 

Sleep Management
Sleep Management Clinical Guidelines
Pain Management Solution Clinical Guidelines
Other Documents

 

Clinical Guidelines

NCDs and LCDS will be used when applicable

  • Clinical Guidelines 
  • Refer to the Utilization Review Matrix document to view specific codes managed by NIA