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:
The following outpatient radiology procedures require you to get prior authorization through NIA.
The ordering physician or clinic is responsible for getting authorization.
If you are providing any of the services above, you should verify that the necessary authorization has been obtained. Not having the necessary authorization could result in non-payment of your claim.
If imaging procedures are needed or performed during an emergency room and/or urgent care visit or in observation and inpatient facilities, they don't require authorization.