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

Wellcare of Kentucky

Welcome to the WellCare of Kentucky Medicare and Medicaid 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, Andrew Dietz.

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. 

Alerts

  • WellCare of KY Medicaid no longer requires an authorization for requests with POS 22 for DOS 8/11/2021 and beyond.
  • Kentucky Department for Medicaid Services recently announced that services performed in an On Campus-Outpatient Hospital setting, POS 22, do not require a prior authorization.

Update on Physical Medicine 

Due to unforeseen operational challenges, these programs have been delayed until further notice. eviCore will continue to manage all rehabilitative and habilitative physical medicine requests for the time being. Therefore, please continue to submit prior authorization requests to eviCore until further notice.  Please look for future communication on this topic.

Advanced Imaging Program

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

Cardiac Program

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

Interventional Pain Management Program

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

Musculoskeletal Program

For access to our Interventional Pain Management 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.