Home State Health
Welcome to the Home State Health page. The documents below have been designed to help RadMD users navigate the prior authorization process for each program Evolent (formerly National Imaging Associates, Inc.) is responsible for. Additional process-specific training tools and modules can be found via links on the Resources tab at the top of the screen.
If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager, Lori Fink.
MEDICARE plans: Effective 8/5/2024, peer-to-peer discussions must be performed before a final determination has been made on the request. Medicare re-opens are only allowed if the request complies with the CMS definition of a re-open. Providers will continue to have the option to submit an appeal utilizing the health plan’s process.
Advanced Imaging Program
- Frequently Asked Questions
- Peer-to-Peer Process
- Provider Education Presentation
- Utilization Review Matrix
For access to our Advanced Imaging tip sheets/checklists, click here.
Cardiac Program
For access to our Cardiac tip sheets/checklists, click here.
Musculoskeletal Program - Effective March 1, 2024
- Frequently Asked Questions
- Provider Education Presentation
- Utilization Review Matrix (Hip, Knee, Shoulder)
- Utilization Review Matrix (Spine)
For access to our Musculoskeletal tip sheets/checklists, click here.
Physical Medicine Program
For access to our Physical Medicine tip sheets/checklists, click here.
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
Low Dose Chest CT History Form
Clinical Guidelines
- Clinical Guidelines
- Click here to view Evolent's Physical Medicine guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.