Superior HealthPlan
Welcome to the Superior HealthPlan 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: Charles Allison.
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 - Pending Approval
- Provider Education Presentation - Pending Approval
- Quick Reference Guide - Pending Approval
- Utilization Review Matrix (Medicaid)
- Utilization Review Matrix (Medicaid Star Plus)
- Utilization Review Matrix (Medicare)
For access to our Advanced Imaging tip sheets/checklists, click here.
Cardiac Program
- Frequently Asked Questions - Pending Approval
For access to our Cardiac tip sheets/checklists, click here.
Genetic Testing Program
- Announcement Letter - Genetic Services Biomarker Testing - Effective 9/1/24
- Checklist
- Frequently Asked Questions
- Provider Education Presentation
- Quick Reference Guide
- Tests and Laboratory Matrix - 12/1/24
For access to our Genetic Testing clinical guidelines, click here.
Musculoskeletal Management Program - Effective January 1, 2024
Conservative Treatment Forms
For access to our conservative treatment forms, click here.
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.