May 27, 2021
In keeping with our commitment of promoting continuous quality improvement for services provided to WellCare of North Carolina members, WellCare of North Carolina has entered into an agreement with National Imaging Associates, Inc. (NIA)1 to implement the following Medical Specialty Solutions Programs:
- Radiology Benefit Management (RBM)
- Cardiac Imaging
- 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 North Carolina members. This decision is consistent with industrywide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.
Under terms of the agreement, WellCare of North Carolina will oversee NIA's programs and continue to be responsible for claims adjudication. NIA will manage the services listed below through WellCare of North Carolina's existing contractual relationships.
Based on a July 1, 2021 implementation, this correspondence serves as notice under your WellCare of North Carolina Provider Agreement of changes to these programs.
Prior authorization will be required for the following outpatient services:
| RBM/Cardiac Procedures (non-emergent advanced outpatient imaging) | Rehabilitative and IPM Procedures | Habilitative Physical Medicine Services |
|---|---|---|
|
|
|
Please note:
- The ordering physician is responsible for obtaining authorization prior to rendering the above-listed services. To obtain authorization, the provider must go to www.RadMD.com, or call NIA's toll-free numbers: 1-866-249-1583 (Medicaid) or 1-800-424-5388 (Medicare).
- Providers rendering the services listed in this letter should verify that the necessary authorization has been obtained by visiting www.RadMD.com, or by calling NIA toll-free at 1-866-249-1583 (Medicaid members) or 1-800-424-5388 (Medicare members). Failure to do so may result in nonpayment of your claim.
- Please keep in mind you will need to ensure that the member's therapy benefit has not been exhausted before providing services, even if an "Approved Authorization" has been obtained. This can be confirmed by calling WellCare of North Carolina Provider Services toll-free at
1-866-799-5318 . - 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 North Carolina 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 North Carolina Provider Services toll-free at
1-866-799-5318.
Sincerely,
WellCare of North Carolina
