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

Wellcare Medicare

Welcome to the Wellcare Medicare 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.

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. 

Effective 1/1/2025, Evolent will no longer service WellCare New Mexico, Alabama, Massachusetts, New Hampshire, Rhode Island, and Vermont. Please refer to the phone number on the back of the member insurance card for services.

If you have any questions about our programs, please contact your dedicated Evolent Provider Relations Manager:

Advanced Imaging Program

For access to State-specific Advanced Imaging Program documents, click below:

For access to our Advanced Imaging tip sheets/checklists, click here.

Cardiac Program

For access to State-specific Cardiac Program documents, click below:

For access to our Cardiac tip sheets/checklists, click here.

Interventional Pain Management Program

For access to State-specific Interventional Pain Management Program documents, click below:

For access to our Interventional Pain Management tip sheets/checklists, click here. 

Musculoskeletal Program

For access to State-specific Musculoskeletal Program documents, click below:

For access to our Musculoskeletal tip sheets/checklists, click here.

Physical Medicine Program

For access to State-specific Physical Medicine Program documents, click below:

Update for Wellcare Connecticut, New York and Tennessee:

  • Home Health Providers submitting claims utilization G-Codes for all home therapy services are excluded from the Physical Medicine Program

Update for Wellcare Kentucky, Louisiana and Connecticut:

  • Effective 07/01/2022 Inpatient and Outpatient Therapy performed in a Home Health Setting is excluded from the 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

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.