High-Tech Imaging Prior Authorization Program
The National Imaging Associates (NIA) High-Tech Imaging Prior Authorization Program applies to Tufts Health Plan Commercial products* and Tufts Health Public Plans products**.*Commercial products include HMO, POS, PPO and Tufts Health Freedom Plan
**Tufts Health Public Plans products include Tufts Health Direct, Tufts Health RITogether, Tufts Health Together – MassHealth MCO Plan and Accountable Care Partnership Plans, and Tufts Health Unify
The following services require prior authorization through NIA’s High-Tech Imaging program. Ordering providers must obtain authorization before requesting outpatient high-tech imaging services. Depending on the member’s plan, providers must contact either National Imaging Associates (NIA) or Cigna.
- CT/CTA scans
- PET scan
- Nuclear cardiology
- Echocardiography/stress echocardiography (prior authorization is not required for members under the age of 18 on the date of service)
- Note: Diagnostic imaging services performed in an emergency department, observation, and/or inpatient settings do not require prior authorization.
- Requests meeting clinical criteria will be assigned an authorization number .
- For non-approved authorizations, a nurse may request additional information, or forward the request to a physician reviewer. The physician reviewer will either approve, request additional information, or deny the service request.
- Only a physician reviewer can issue a medical necessity denial.
- For a list of procedure codes subject to prior authorization by NIA, refer to the High-Tech Imaging and Cardiac Program Prior Authorization Code Matrix.
- For additional information, refer to:
- For additional information on cardiac prior authorization, refer to:
- To obtain and verify authorizations or access medical necessity guidelines, log in to RadMD or call 866.642.9703 for Commercial products or 800.207.4209 for Tufts Health Public Plans products.
- Providers in MA can fax the appropriate standard imaging form to NIA at 866.642.9703.
- Authorizations can also be verified through the secure Provider website via the Referral Inquiry screen — authorizations viewed in this screen are for the service only and do not replace any required referrals to specialists. Authorization numbers beginning with a Y are approved; numbers beginning with an N are denied.
Note: The NIA High-Tech Imaging program does not apply to members of Tufts Medicare Complement, Commercial PPO plans with a PHCS or Cigna network, CareLinkSM, Uniformed Services Family Health Plan (USFHP), Tufts Medicare Preferred HMO, Tufts Medicare Preferred Supplement, or Tufts Health Plan Senior Care Options.
- To obtain and verify authorizations: ordering providers are required to call Cigna at 800.244.6224 prior to scheduling high-tech imaging services. All rendering physicians are responsible for ensuring approved authorization before rendering services.
- Refer to the Cigna website for more information about medical necessity criteria for high-tech imaging.