July 30, 2021
Dear Provider,
Beginning September 1, 2021, WellCare of Kentucky is pleased to announce that we are expanding our partnership with National Imaging Associates, Inc. (NIA)1, to provide utilization management for the following Medical Specialty Solutions Programs:
- Interventional Pain Management (IPM)
- Rehabilitative and Habilitative Physical Medicine
These programs include management of Medical Specialty Solutions services to include prior authorization for WellCare of Kentucky members. This decision is consistent with industry efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
WellCare of Kentucky will oversee NIA's programs and continue to be responsible for claims adjudication. NIA will manage the services listed below through WellCare of Kentucky's existing contractual relationships.
Based on a September 1, 2021 implementation, this correspondence serves as notice under your WellCare of Kentucky's Provider Agreement of changes to these programs.
Prior authorization will be required for the following outpatient services:
| IPM Procedures | Rehabilitative and Habilitative Physical Medicine Services |
|---|---|
|
|
In addition, prior authorization will also be required for the following CPT codes through NIA’s Rehabilitative and Habilitative Physical Medicine Program effective September 1, 2021. Prior to September 1, 2021, the CPT codes did not require prior authorization.
20560
20561
92606
92612
97545
97546
Please note the following:
- The ordering physician must obtain authorization before rendering the previously listed services. To obtain authorization, the provider should go to www.RadMD.com, or through the NIA dedicated toll-free phone number for Medicare 1-800-424-5388.
- Providers rendering the services previously listed should verify that the necessary authorization has been obtained by visiting www.RadMD.com, or by calling NIA (Medicare) at 1-800-424-5388. Failure to do so may result in nonpayment of your claim.
- Emergency room and inpatient Medical Specialty Solutions services do not require authorization through NIA.
We appreciate your support and look forward to your assistance in assuring that WellCare of Kentucky's members receive these services delivered in a quality, clinically appropriate manner.
We will provide additional information as we get closer to the implementation date. If you have questions at this time, please call WellCare of Kentucky Provider Services at 1-877-389-9457.
Sincerely,
WellCare of Kentucky
1National Imaging Associates, Inc. (NIA) is a subsidiary of Magellan Healthcare, Inc.
