provider connection
 

National Imaging Associates

Blue Shield of California is contracted with National Imaging Associates, Inc. (NIA) to provide medical necessity reviews and prior authorization for selected outpatient radiology procedures within the state of California.

NIA reviews requests on Blue Shield of California underwritten PPO and Direct Contract Network HMO members only. NIA also provides provider site quality assessment services for our network of preferred imaging providers.

NIA reviews are not required for:

  • Blue Shield HMO members (other than Direct Contract Network members), but authorization from the member's IPA or medical group may be needed
  • Federal Employees Program (FEP) members
  • Members covered by Blue Cross Blue Shield plans of other states
  • Blue Shield of California members who reside outside of California
  • Members covered by employer ASO plans.

NOTE - Within 5 days before the actual date of service, providers MUST confirm with Blue Shield that the member's health plan coverage is still in effect.

Blue Shield reserves the right to revoke authorizations prior to services being rendered based on cancellation of the member's eligibility. Final determination of benefits will be made after review of the claim for limitations or exclusions.

The goal of this imaging management program is to improve the quality, accountability, and cost of imaging services to our members.

To accomplish this goal, NIA coordinates with referring providers to assure imaging services are appropriate compared to national standard clinical protocols.


Services Reviewed

Outpatient non-emergency imaging examinations of the following types are reviewed:

  • CT (computerized axial tomography), all examinations
  • MRI (magnetic resonance imaging), all examinations
  • MRA (magnetic resonance angiography), all examinations
  • PET (positron emission tomography), all examinations
  • Cardiac nuclear medicine studies (e.g. nuclear cardiac stress test)

Services are not reviewed for the following:

  • Hospital emergency room
  • Inpatient imaging services
  • Observation bed
  • Out of state services
  • Outpatient surgery - incidental imaging.

Contacts

NIA website: www.RadMD.com

NIA telephone number: (888) NIA-BLUE (642-2583)

Authorization requests and status information can be obtained by calling the NIA telephone call center. Authorization status for a provider's patients can also be checked on-line at the NIA website. The RadMD.com website also provides additional information about NIA and its services.