Magnolia Health Plan (Magnolia)  has contracted with National Imaging Associates Inc. (NIA), an affiliate of Magellan Health Services, for radiology benefit management.

The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization.  This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Magnolia oversees the NIA program and is responsible for claims adjudication.  NIA manages non-emergent outpatient imaging/radiology services through contractual relationships with free-standing facilities.

Prior authorization is required for the following outpatient radiology procedures:

• CT/CTA/CCTA
• MRI/MRA
• PET Scan

KEY PROVISIONS:

• Emergency room and observation do not require authorization.  (Inpatient admissions will continue to be pre-managed through Medicaid’s current vendor, HealthSystems of Mississippi.)
• Providers rendering the above services should verify that the necessary authorization has been obtained.  Failure to do so may result in non-payment of your claim.

To obtain a prior authorization, go to the NIA Website, www.RadMD.com.

To obtain a prior authorization for Nuclear Studies, call 1-866-912-6285.