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
Cardiac (applicable for Medicare Advantage only)
Hip, Knee, and Shoulder Surgeries