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Here you can access our clinical guidelines and resources, as well as useful information related to the programs shown on the left hand side of this page You may contact your dedicated nia provider relations manager We strongly recommend using radmd to request a prior authorization
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If you do need to call, please use the phone number that has been designated for your evolent prior authorizations Who can a provider contact at nia for more information You have instant access to the imaging authorization and supporting information you need on this site
Whether submitting imaging exam requests or checking the status.
Our system provides instant access to much of the prior authorization information that our call center staff provides Clinical guidelines 2025 advanced imaging guidelines checklists advanced imaging checklist low dose chest ct history form tip sheets advanced imaging test request tip. These medical necessity criteria were developed by evolent for the purpose of making clinical review determinations for requests for therapies and diagnostic procedures The developers of the criteria sets included representatives from the disciplines of radiology, internal medicine, nursing, cardiology, and other specialty groups
Evolent’s guidelines are reviewed yearly and modified. Preamble nia is committed to the philosophy of supporting safe and effective treatment for patients The medical necessity criteria that follow are guidelines for the provision of diagnostic imaging These criteria are designed to guide both providers and reviewers to the most appropriate diagnostic tests based on a patient’s unique circumstances
In all cases, clinical judgment.
Nia’s clinical guidelines are on radmd.com* under online tools/clinical guidelines Nia’s guidelines for medical specialty solutions services were developed from practice experience, literature reviews, specialty criteria sets and empirical data An authorization number isn’t a guarantee of payment. Click here for a complete list of telephone numbers.
