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Our system provides instant access to much of the prior authorization information that our call center staff provides There are two ways to send clinical information Nia’s guidelines are reviewed yearly and modified when necessary following a literature search of pertinent and established clinical guidelines and accepted diagnostic imaging practices.
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These medical necessity criteria were developed by national imaging associates, inc Validation of clinical criteria within the member’s medical records is required when requested (nia) for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures.
What information does nia require before a medical necessity review can be initiated for prior authorization determination
How does the ordering provider obtain a prior authorization from nia for a medical specialty solutions outpatient service What information is required to receive prior authorization? At least two convenient callback times will need to be provided to ensure nia staff is available to make the call. How long does it take nia to make a determination on a prior authorization request
Once all required clinical information is received to complete the medical necessity review, generally a determination will be provided within two business days How can providers track the status of medical Please utilize the nia specific fax coversheet to ensure prompt receipt of your faxes proper submission of faxes will ensure clinical information is received for a prior authorization request and for determination to be made Evolent may request member medical records/additional clinical information
