On behalf of BlueCross, NIA handles precertification for certain advanced imaging services for some groups. NIA is an independent company.
Urgent care facilities must get precertification for these advanced imaging services when they are performed and billed in an outpatient or office setting. See our Claims Resolution Matrix for a complete list of services that require precertification.
There are two ways to get authorizations:
NIA’s Web site hours of operation are Monday through Friday, 5 a.m. to 12 a.m. EST and Saturday 8 a.m. to 1 p.m. EST. To get authorizations each user in your office will need to get his or her own unique username and password. Simply visit www.RadMD.com, click on the “New User” button and complete the application form. If you request an authorization through NIA’s Web site and your request is pended, you will receive a tracking number and NIA will contact you to complete the process.
NIA call center hours of operation are Monday through Friday, 8 a.m. to 8 p.m. EST. You can get prior authorization by calling 866-500-7664. (The rendering facilities should conduct studies physicians order after normal business hours or on weekends as the ordering physician requests. The ordering physician, however, must contact NIA within 24 hours or the next business day to get proper authorization for the studies, which will still be subject to medical necessity review.)
If the patient was seen outside of NIA operation hours (for example, on the weekend) you can get retro authorizations within 48 hours of the date of service. Failure to get an authorization could result in a claim denial.
You can request urgent reviews. NIA processes these within one business day. NIA processes routine reviews within two business days.
Visit our Web site for more information, including a complete listing of groups whose members require authorization through NIA, NIA Reference Guides and frequently asked questions.
For more information, see the following: