Carelon Musculoskeletal, Interventional Pain Management, Cardiology and Radiology
Effective for dates of service on and after Oct. 1, 2024, Medica has partnered with Carelon, a utilization management (UM) program vendor, to support the provider submission and medical necessity review process for select musculoskeletal (MSK), cardiology, and radiology services. Submissions and review by Carelon will replace those previously managed by NIA Magellan.
The following information applies to the NIA (Evolent) program, for dates of service on or prior to Sept. 30th 2024. Authorizations obtained through NIA (Evolent) will be available for viewing through 12/31/2024.
Medica works with National Imaging Associates (NIA) for review and authorization of our Musculoskeletal (MSK) Care Management Program. This includes prior authorization by the treating physician for non-emergent inpatient and outpatient musculoskeletal surgeries, specifically hip, knee, shoulder, lumbar, and cervical spine.
This program incorporates the following key components:
Only inpatient total knee arthroplasty and total hip arthroplasty will require prior authorization.
For questions, contact NIA's customer service representatives: 866-307-9729, available 7 a.m. - 7 p.m. CT, Monday - Friday.