Harvard Pilgrim has a partnership with National Imaging Associates, Inc. (NIA) to oversee prior authorization programs for certain services, including cardiac diagnostic tests and interventional procedures; diagnostic imaging; sleep studies; hip, knee, and shoulder surgery; spine surgery and cervical spine procedures; and outpatient interventional spine pain management services. You’ll find some resources for these programs here, and these and other educational materials are also available on NIA’s www.RadMD.com website.

Utilization Review Matrixes

• NIA 2019 Utilization Review Matrix for Medicare Advantage
• NIA 2019 Utilization Review Matrix for Commercial Members
• Utilization Review Matrix for Interventional Pain Management and Musculoskeletal Surgery

Cardiac Diagnostic Tests/Interventional Procedures — Commercial members

• Cardiac Checklist
• Cardiac Frequently Asked Questions
• Cardiac Quick Reference Guide
• Cardiac Tip Sheet

Cardiac Diagnostic Tests/Interventional Procedures — Medicare Advantage

• Cardiac Program Frequently Asked Questions for Providers
• Cardiac Program Quick Reference Guide for Providers
• Cardiac Checklist

Hip, Knee, and Shoulder Surgeries

• Hip, Knee, and Shoulder Surgeries FAQ

Musculoskeletal Surgery

• MSK Program Quick Reference Guide
• MSK FAQs for Ordering Physicians

Sleep Management

• Sleep Management Program FAQ