National Imaging Associates (NIA)
Advanced Diagnostic Imaging
Iowa Total Care has contracted with National Imaging Associates Inc. (NIA) for radiology benefit management.
The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
Iowa Total Care oversees the NIA program and is responsible for claims adjudication. NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with freestanding facilities.
Prior authorization is required for the following outpatient radiology procedures:
- PET Scan
Iowa Total Care, in collaboration with NIA, will launch a cardiac imaging program to promote health care quality for patients with possible cardiac disease.
Under this program, prior authorization will be required for certain cardiac studies to determine if the cardiac test or procedure is the most appropriate next step in a patient’s diagnosis or treatment—and to recommend an alternate approach when indicated. By supporting the most efficient diagnosis and management of cardiac disease, NIA addresses unnecessary procedures and promotes the least invasive, most medically appropriate approach.
Prior Authorization is required for the following cardiac procedures through NIA:
- Myocardial Perfusion Imaging (MPI)
- MUGA Scan
- Stress Echocardiography
Interventional Pain Management (IPM)
Effective June 1, 2023, the prior authorization program with NIA will be expanded to include the following non-emergent outpatient Medical Specialty Solution procedures:
- Spinal Epidural Injections
- Paravertebral Facet Joint Injections or Blocks
- Paravertebral Facet Joint Denervation (Radiofrequency (RF) Neurolysis)
- Sacroiliac Joint Injections
- Spinal Cord Stimulators
Providers may begin contacting NIA on June 1, 2023, to seek prior authorization for procedures scheduled on or after June 1, 2023. NIA will manage these procedures through Iowa Total Care’s contractual relationships.
- Interventional Pain Management Checklist
- Interventional Pain Management Provider FAQ
- Interventional Pain Management Provider Training PowerPoint
- Interventional Pain Management 2023 Quick Reference Guide
- Interventional Pain Management Utilization Review Matrix 2023
Physical Medicine (Therapy) Program
Effective April 1, 2022, outpatient physical, occupational and speech therapy requests will be reviewed by NIA’s peer consultants to determine whether the services meet policy criteria for medically necessary and appropriate care. The medical necessity determinations are based on a review of objective, contemporaneous, and clearly documented clinical records that may be requested to help support the appropriateness of care. Clinical review helps determine whether such services are both medically necessary and eligible for coverage.
All members are eligible for four (4) visits per rolling benefit year, per discipline without authorization. All other visits and CPT codes following the four (4) visits will require authorization through NIA prior to services being rendered and billed. Prior authorization can be obtained through the NIA website or by contacting NIA at 866-493-9441.
- Physical Medicine (Therapy) Peer to Peer Process
- Physical Medicine (Therapy) PowerPoint (PDF)
- Physical Medicine (Therapy) Provider FAQ (PDF)
- Physical Medicine (Therapy) Quick Reference Guide (PDF)
- Physical Medicine (Therapy) Re-Review Process
- Physical Medicine (Therapy) Tip Sheet Checklist (PDF)
Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim.
Go to the NIA website for more information.
NIA Education Material
Provider education material is located on the NIA website. Educational resources include quick reference guides, tip sheets, frequently asked questions, and a recorded webinar that outlines how to submit a prior authorization.