WellCare of New Jersey
Welcome to the WellCare of New Jersey 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, Seth Cohen.
Physical Medicine Program
- Physical Medicine FAQs
- Physical Medicine Tip Sheet/Checklist
- Physical Medicine Quick Reference Guide
- Physical Medicine Provider Training
- Physical Medicine Provider Training Video
Interventional Pain Management (IPM) Program
- IPM FAQs
- IPM Checklist
- IPM Quick Reference Guide
- IPM Provider Training
- IPM Utilization Review Matrix 2022
- IPM Conservative Treatment Form
- IPM Provider Training Video
Advanced Imaging and Cardiac Study Documents
- RBM Frequently Asked Questions
- RBM Ordering Provider Quick Reference Guide
- RBM Rendering Provider Quick Reference Guide
- Provider Education PowerPoint
- Prior Authorization Checklist
- Cardiac Solutions Frequently Asked Questions
- Cardiac Solutions Tip Sheet
- Utilization Review Matrix (Medicaid)-2022
- Utilization Review Matrix (Medicare)-2022
- Medical Specialty Solutions Provider Training
- Imaging Conservative Treatment Form
- Peer-to-Peer Process
News and Updates
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.
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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.
2013 Jimmo vs Sebelius Settlement Agreement
Click here for information about the 2013 Jimmo v. Sebelius settlement involving skilled nursing and skilled therapy services.
Clinical Guidelines
- Clinical Guidelines
- Refer to the Utilization Review Matrix document to view specific codes managed by NIA
- Click here to view NIA’s Physical Medicine guidelines
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).