National Imaging Associates (NIA)

Buckeye Health Plan has contracted with National Imaging Associates Inc. (NIA) 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.

Buckeye Health Plan 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 PROVISION:

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.

Go to the NIA website for more information.

Resources:

How to file an NIA appeal

Medicaid

Providers can request an appeal in writing or by calling the number below within sixty (60) days of the denial letter date.

Appeal rights include, the right to review the contents of the case file and to submit additional records or information. Appeals can be requested by writing or by calling us.

You can file an appeal by the following methods:

Phone: 1-866-972-9842 (must also send a written, signed appeal)
Fax: 1-888-656-0701
Letter via postal mail to:

National Imaging Associates, Inc.
Attn: Appeals Department
P.O. Box 1495
Maryland Heights, MO 63043

The written appeal should include the following information:

Provider name
Member number
Provider phone number
Why you think we should change the decision
Medical information to support the request

You will be notified of a decision:

Service not complete: within ten (10) calendar days of your appeal request.
Service complete: within thirty (30) calendar days of your appeal request.

Expedited Appeal:

If you believe that waiting up to 30 calendar days for a decision could seriously risk the patient’s life or health, including being able to reach, keep, or get back to maximum function, tell us when asking for an appeal. If we agree, we will make a decision within 72 hours of receiving the request. An expedited appeal may be filed orally. It does not have to be filed in writing.

Ambetter/Exchange

Providers can request an appeal in writing or by calling the number below within one hundred eighty (180) days of the denial letter date.