Physical Health (PT/OT)

National Imaging Associates (NIA) has been carefully selected by Prevea360 Health Plan to administer the authorization program for providers. The program applies to members who are being treated by a Prevea360 Health Plan-contracted physician as well as all non-contracted physicians who have been authorized to provide physical medicine services (some account exclusions apply).

  • The member’s initial eight visits (inclusive of the evaluation visit) within each plan year will require a Care Registration authorization.
  • If additional treatment (beyond the initial eight visits) is anticipated, prior authorization is necessary and should be submitted just prior to the ninth visit. Authorization requests should be submitted through the RAD MD web portal within 10 days of evaluating your patient for additional care.
  • Authorization for treatment will be based on Prevea360 Health Plan standards for medical necessity and is a requirement for reimbursement.
  • NIA only authorizes the medical necessity of the services. Please note that any of the benefit limitations will apply to any services that are authorized as medically necessary.
  • Members who require the services of a provider who is not a Prevea360 Network provider will require two (2) authorizations:
    • Prevea360 authorization to use the non-plan provider
    • NIA authorization of the medical necessity of the services (if the visits are beyond the initial eight visits indicated above)

We’re Here to Help
If you have any questions please contact NIA at 877.642.0622 or our Customer Care Center at 877.230.7555 with any additional questions.

Resources

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Please Note
Practitioners who perform services without a prior authorization may experience claim denials. Providers can only bill the member for these services if the member completed a standard waiver form that your office uses, and if Prevea360 Health Plan does not allow payment for these services.