High-Tech Imaging Prior Authorization Program through NIA
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, USFHP (effective April 1, 2021) 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
Effective for dates of service on or after April 1, 2021, this program will also apply to U.S. Family Health Plan members.
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 NIA or Cigna.
- CT/CTA scans
- PET scans
- Nuclear cardiology
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.
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.
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 form to NIA at 800.784.6864.
Commercial authorizations can also be verified through the secure Provider portal — authorizations viewed in this screen are for the individual 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, 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.