Evolent (formerly National Imaging Associates) ― Diagnostic Imaging Services

AmeriHealth Caritas Next has an agreement with Evolent, formerly National Imaging Associates, Inc. (NIA), to manage diagnostic imaging services such as MR/CT/PET.

The program will require prior authorization from Evolent for nonemergent outpatient:

• CT/CTA
• CCTA
• MRI/MRA
• PET scan
• MUGA scan
• Myocardial perfusion imaging (MPI)

The physician ordering the procedures noted above is responsible for obtaining prior authorization. The rendering facility must ensure that prior authorization was obtained.

We recommend that you develop a process to ensure that the appropriate authorization number(s) has been obtained. Payment to the ordering physician and rendering facility will be denied for procedures performed without necessary authorization.

Providers can request prior authorization via Evolent's RadMD tool or by calling Evolent at 1-800-424-4792.

If you have questions about submitting a prior authorization, please call the number above or reference the following materials:

• Prior Authorization Checklist ― this document details the information you need to gather before asking for a prior authorization.
• Frequently Asked Questions (PDF)
• AmeriHealth Caritas Next/NIA Billable CPT^® Codes (PDF) ― Claim Resolution/Utilization Review Matrix for all of the CPT-4 codes that NIA authorizes on behalf of AmeriHealth Caritas Next.
• Quick Reference Guide (PDF) for ordering and rendering providers.
• Provider Education Module (PDF) ― if you would like a NIA representative to provide NIA training to your staff, please call NIA Provider Relations Representative Priscilla Singleton at 1-314-387-5023 ext. 75023.