Presbyterian Health Plan
Welcome to the Presbyterian 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, Gina Braswell.
News and Updates
Notice About Authorization Letters for Advanced Radiology Services and Lumbar
Advanced Imaging Program
- Medical Specialty Solutions Utilization Review Matrix-2022 - Updated 7/1/2022
- Medical Specialty Solutions FAQ
- Medical Specialty Solutions QRG
- Medical Specialty Solutions Program is Replacing Health Help
- Tip Sheet for Imaging
- Tip Sheet for Imaging for Pediatrics
- Provider Training PPT
- Prior Authorization Checklist
- Peer-to-Peer Process
- Authorization Process for Expedited/Urgent Requests
Spine Care Program
- NIA Frequently Asked Questions (FAQ’s)
- Spine Management Surgery Utilization Review Matrix-2022
- Spine Management Provider Presentation
- Spine Pain Management Quick Reference Guide for Ordering Physicians/Surgeons
- Spine Surgery Checklist
Cardiac Program
- Medical Specialty Solutions Utilization Review Matrix-2022 - Updated 7/1/2022
- Cardiac Solutions Tip Sheet
- Medical Specialty Solutions Cardiac Checklist
- Medical Specialty Solutions Cardiac Imaging FAQ
- MPI versus Stress Echo Tip Sheet
Prior Authorization Form
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.
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).