Welcome to the Wellcare of Rhode Island 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.

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

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
• Peer-to-Peer Process
• Provider Education Presentation
• Quick Reference Guide
• Utilization Review Matrix

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

Cardiac Program

• Frequently Asked Questions

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

Musculoskeletal Program - Effective April 1, 2024

• Frequently Asked Questions
• Provider Education Presentation
• Quick Reference Guide
• Utilization Review Matrix (Hip, Knee, Shoulder Surgery)
• Utilization Review Matrix (Spine Surgery)

For access to our Musculoskeletal 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
• Refer to the Utilization Review Matrix document to view specific codes managed by Evolent.