High-Tech Imaging Change

January 20, 2021
High-Tech Imaging Change

National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Health, will manage QualChoice diagnostic and cardiac imaging.

QualChoice has entered into an agreement with National Imaging Associates, Inc. (NIA), a subsidiary of Magellan Health, to manage a suite of medical specialty solutions. The program is consistent with industry-wide efforts to manage the increasing utilization of these services and to ensure quality of care.

Effective March 1, 2021, eviCore will no longer administer high-tech imaging and nuclear medicine for QualChoice. NIA will manage diagnostic (MR/CT/PET) and cardiac imaging services through QualChoice contractual relationships.

Prior authorization from NIA will be required for these non-emergent outpatient diagnostic Imaging services:

  • MR
  • PET
  • Nuclear Cardiology/MPI
  • Stress Echo
  • Echocardiography
Physicians ordering these procedures are responsible for obtaining prior authorization. The rendering facility must ensure that prior authorization is in place. We urge you to develop a process to ensure that the appropriate authorization number(s) has been obtained. Payment to the ordering physician and rendering facility will be denied for procedures performed without necessary authorization.

CPT® codes that NIA authorizes on behalf of QualChoice will be available at RadMD.com in the QualChoice/NIA Billable CPT® Codes Claim Resolution/Utilization Review Matrix.

Training Webinars

NIA will present hour-long educational sessions on the dates listed below. Only one session is required. Watch for additional communications on the webinars.

For questions, call NIA at 1.866.249.1587 or QualChoice Customer Service at 1.800.235.7111.