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

Health Plans

Harvard Pilgrim Health Care

Welcome to the Harvard Pilgrim HealthCare 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, April Sabino

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

State Authorizations and Requirements

Cardiac Program

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

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.

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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.

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   

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).