High-Tech Imaging Program
Depending on the member's plan, providers must contact either National Imaging Associates' (NIA) or Cigna for high-tech imaging prior authorizations, for the following services:
- CT/CTA scans
- PET scans
- Nuclear cardiology
While you may not be the provider responsible for obtaining prior authorization, as a condition of payment, you must confirm prior authorization has been obtained.
NIA High-Tech Imaging Program
Tufts Health Plan requires Commercial (including HMO, POS, PPO and Uniformed Services Family Health Plan [USFHP]) and Tufts Health Public Plans providers to obtain prior authorization through NIA.
Note: The NIA High-Tech Imaging program does not apply to Senior Products (including Tufts Medicare Preferred and Tufts Health Plan Senior Care Options [SCO]), Commercial plans using the Cigna network or CareLink SM.
To request 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.
Massachusetts providers may also fax the applicable form, with member ID and/or NIA tracking number, to NIA at 800.784.6864:
Commercial authorizations can also be verified through Tufts Health Plan's 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.
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.
Cigna/CareLink High-Tech Imaging Program
To obtain and verify authorizations: ordering providers are required to call Cigna at 800.244.6224 prior to scheduling high-tech imaging services. Refer to the Cigna website for more information about medical necessity criteria for high-tech imaging.