These medical necessity criteria were developed by National Imaging Associates, Inc. (NIA) for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures. The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, cardiology, and other specialty groups. NIAs guidelines are reviewed ...
What information does NIA require before a medical necessity review can be initiated for prior authorization determination? Radiation Oncologist should have all of the following informati n available before logging on to NIA’s website, https://www.RadMD.com or by When should requests for medical necessity review be submitted?
NIA’s Clinical Guidelines are on RadMD.com* under Online Tools/Clinical Guidelines. NIA’s guidelines for Medical Specialty Solutions services were developed from practice experience, literature reviews, specialty criteria sets and empirical data. An authorization number isn’t a guarantee of payment.
The following non-emergent, outpatient, Medical Specialty Solutions services require prior authorization through NIA effective : CT/CTA MRI/MRA PET Scan CCTA MUGA Scan Myocardial Perfusion Imaging (MPI) Emergency room, observation and inpatient procedures do not require prior authorization from NIA. If an urgent/emergent clinical situation exists outside ...
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