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New preapproval rules, effective January 1

 

Starting January 1, 2019, National Imaging Associates, Inc. (NIA) will authorize certain services on our behalf for New Jersey and Western New York. The program applies to our insured business HMO, PPO and Medicare plans.

 

Authorizations
 

Services that require preapproval:

  • Physical therapy services performed by any provider.
  • Occupational therapy services performed by any provider.
  • Chiropractic services performed by any provider.

In addition to the expansion areas of New Jersey and Western New York, providers in the bordering states of PA, DE, WV, and in eastern New York, who deliver services to members in these states must also get preauthorization.

 

For a full list of procedures that need an authorization, log in to NIA’s website.

 

The NIA program doesn’t apply to therapy performed in certain places, including:

 

  • An inpatient setting, including skilled nursing facilities.
  • A home setting.
  • An urgent or emergent care setting.

 

How to request prior authorization online

 

In the coming weeks, you’ll get more information from NIA, including details about training and more information on the authorization process for physical therapy, occupational therapy and chiropractic codes.

 

You can start requesting authorization for these services beginning December 17, 2018, for dates of service January 1 and after. Just log in to the NIA website.

 

Have questions? Need more information?

 

Visit NIA.

For general information, call our provider services center at:

  • 1-800-624-0756 for HMO and Medicare Advantage plans
  • 1-888-632-3862 for PPO plans