NIA to provide utilization management for Interventional Pain Management (IPM) services for Ambetter of North Carolina Inc members

Date: 03/31/23

Beginning June 1, 2023, Ambetter of North Carolina Inc. is pleased to announce our expanded partnership with National Imaging Associates, Inc. (NIA) to provide utilization management for Interventional Pain Management (IPM) services for Ambetter of North Carolina Inc.’s members. This program is consistent with industry-wide efforts ensuring that IPM services provided to our members are consistent with nationally recognized clinical guidelines.

Under terms of the agreement between Ambetter of North Carolina Inc. and NIA, Ambetter of North Carolina Inc. will oversee the IPM program and continue to be responsible for claims adjudication and medical policies. NIA will manage non-emergent outpatient IPM procedures through the existing contractual relationships with Ambetter of North Carolina Inc.

Planned for a June 1, 2023 implementation, this correspondence serves as notice under your Participating Ambetter of North Carolina Inc. Provider Agreement of changes to the program.

Providers may begin contacting NIA on June 1, 2023 to seek prior authorization for procedures scheduled on or after June 1, 2023.

Prior authorization will be required for the following non-emergent outpatient IPM procedures:

• Spinal Epidural Injections
• Paravertebral Facet Joint Injections or Blocks
• Paravertebral Facet Joint Denervation (Radiofrequency (RF) Neurolysis)
• Sacroiliac Joint Injections
• Sympathetic Nerve Block

KEY PROVISIONS:

• It is the responsibility of the ordering physician to obtain prior authorization for all IPM procedures outlined above.
• The ordering physician must obtain prior authorization with NIA prior to performing the procedure.
• To obtain authorization, the provider should visit www.RadMD.com or call the NIA dedicated toll-free phone number: 1-800-424-4948. Failure to do so may result in nonpayment of your claim.

Services other than the IPM procedures outlined above will continue to follow Ambetter of North Carolina Inc.’s prior authorization requirements.

We appreciate your support and look forward to your assistance in ensuring that Ambetter of North Carolina Inc. members receive IPM procedures delivered in a quality, clinically appropriate fashion.

We will provide additional information as we get closer to the implementation date. Should you have questions at this time, please contact Ambetter of North Carolina Inc. Provider Services at 1-833-863-1310.

Quick Reference Guide for Ordering Providers (PDF)

Frequently Asked Questions for Providers (PDF)