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Network Matters
News and Information for the
Harvard Pilgrim Health Care Network

June 2014

Prior Authorization Requests for Spine Procedures Accepted Beginning June 23 


As a reminder, Harvard Pilgrim will require prior authorization on selected spinal surgeries and injections beginning July 1, 2014, and providers can begin making prior authorization requests on June 23. Harvard Pilgrim has chosen National Imaging Associates, Inc. (NIA) to implement the spine management and prior authorization program, and NIA will be processing prior authorization requests from ordering physicians for the following:

  • Non-emergent inpatient and outpatient spine surgeries:  lumbar microdiscectomy; lumbar decompression (laminotomy, laminectomy, facetectomy, and foraminotomy); and lumbar spine fusion (arthrodesis)
  • Non-emergent outpatient interventional spine pain management services: spinal epidural injections; paravertebral facet joint injections or blocks; paravertebral facet joint denervation [Radiofrequency (RF) Neurolysis]

You may request prior authorization through the NIA website (www.RadMD.com) or by phone (800-642-7543).

Enroll in a Webinar
We’ve been conducting webinars for providers who would like to learn more about this change, and have webinars scheduled on the following dates:

  • Tuesday, June 17 — 8 a.m. and 12 p.m.
  • Thursday, June 19 — 4 p.m.
  • Thursday, June 26 — 8 a.m. and 12 p.m.

These webinars will include detailed clinical and procedural information (the clinical guidelines being used, clinical information required for a prior authorization, steps for obtaining prior authorization, response time, etc), and you’ll have an opportunity to receive answers to any questions you may have. You will need a computer with Internet access to view the educational materials presented during the webinar. To enroll in one of these sessions, please call NIA at 800-327-0641. After you sign up for the webinar, you will receive an email confirmation that includes your toll-free dial-in number, access code, and web meeting address.

More Information Available
For more detailed information on this program, please refer to the following materials developed by Harvard Pilgrim and NIA:

If you have any further questions, please contact the Provider Service Center at 800-708-4414.

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PUBLICATION INFORMATION

Eric H. Schultz,
President and Chief Executive Officer

Richard Weisblatt PhD,
Senior Vice President, Provider Network

Annmarie Dadoly,
Editor

Kristin Edmonston,
Production Coordinator