CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

NIA Magellan Radiology Prior Authorization (group prefixes)

Governs prior authorization requirements via National Imaging Associates (NIA) Magellan Healthcare for certain outpatient advanced imaging and radiology services for specified BlueCross BlueShield of South Carolina fully insured and ASO groups.

Policy Summary

PayerBlue Cross Blue Shield - South Carolina

PolicyNIA Magellan Radiology Prior Authorization (group prefixes)

Policy CodePolicy N/A

Change TypeNo material changes

Effective DateN/A

Next Review DateN/A

Key ActionObtain prior authorization from NIA Magellan for MRIs, MRAs, PET scans and other advanced outpatient radiology services for listed group prefixes.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

multiplegroup prefix mappings listed

continuedadditional group prefixes across chunks

noteprefix scope note

MRIs/MRAs/PET/CTsadvanced radiology services requiring PA

Prior Authorization Criteria by Group

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PA criteria by group prefix

Prior authorization required for members belonging to the listed group prefixes for advanced imaging services (e.g., MRI, MRA, PET, CT). Verify member benefits as the list may not be exhaustive.

Member's group prefix is one of the prefixes listed below (see source chunks 2–4).

Prior Authorization & Verification Required

Prior Authorization

Prior authorization required via NIA Magellan

BlueCross BlueShield of South Carolina requires prior authorization from National Imaging Associates (NIA) Magellan Healthcare for certain outpatient imaging and radiology services; the listed group prefixes will require a PA for MRIs, MRAs, PET scans and other advanced radiology services (including CTs).

Documentation Required

Verify member benefits to confirm PA requirements

Prefixes shown in this notice represent fully insured and Administrative Services Only (ASO) groups but may not be exhaustive; providers must check the member's benefits to verify whether a prior authorization is required for advanced radiology services.

Key Definitions

NIA Magellan — definition

OrganizationNational Imaging Associates (NIA) Magellan Healthcare

RoleUtilization management vendor providing prior authorization for certain outpatient imaging and advanced radiology services on behalf of BlueCross BlueShield of South Carolina

RelationshipNIA is a subsidiary of Magellan Healthcare that performs imaging utilization review for the payer

Group prefixes (scope note)

Scope of prefixesListed group prefixes correspond to fully insured and Administrative Services Only (ASO) groups

CompletenessThe prefix list may not be all-inclusive; additional groups may exist beyond those listed

Action requiredVerify the member's benefits to confirm whether a prior authorization is required for advanced radiology services