CurrentBlue Cross Blue Shield - South CarolinaPolicy N/A

NIA Magellan Radiology Prior Authorization Group Prefixes

This document lists group prefixes that require prior authorization via National Imaging Associates (NIA) Magellan for certain outpatient advanced radiology services for BlueCross BlueShield of South Carolina fully insured and ASO members.

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 advanced outpatient radiology services when the member's group prefix is listed.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

6source text chunks

multiplegroup prefixes enumerated

advanced imagingexamples requiring PA

fully insured/ASOmembership types noted

When Prior Authorization Applies

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 advanced outpatient radiology services when the member's group prefix is listed.

SourceLink

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ALL of the following

Member group prefix matches one of the prefixes listed for NIA Magellan Radiology Prior Authorization (see Group Prefixes list).
Prefixes represent fully insured and Administrative Services Only (ASO) groups; list may not be exhaustive.
Requested service is an outpatient advanced radiology procedure (examples: MRI, MRA, CT, PET, or other advanced imaging).

Confirm prior authorization requirements by verifying the member's benefits with the payer or NIA Magellan before scheduling or performing the service.

Actions Providers Must Take

Prior Authorization

Prior Authorization Required

BlueCross BlueShield of South Carolina requires prior authorization (PA) from National Imaging Associates (NIA) Magellan Healthcare for certain outpatient imaging and advanced radiology services (for example, MRIs, MRAs, CTs, PET scans). NIA Magellan is an independent utilization management vendor that manages these PAs on behalf of BlueCross. Providers must obtain PA from NIA Magellan when applicable to avoid claim denials or delays.

Applies to certain outpatient advanced imaging and radiology services (MRI, MRA, CT, PET, etc.).
Prior authorization must be obtained from NIA Magellan (National Imaging Associates) for affected services.
NIA Magellan is an independent company providing utilization management services for BlueCross BlueShield of South Carolina.

Note

Benefit Verification Required

Verify member benefits and coverage prior to scheduling advanced radiology services. The prefixes listed below represent fully insured and Administrative Services Only (ASO) groups and indicate plans that may require NIA Magellan prior authorization, but this list may not be exhaustive. Always confirm the individual member's benefit details and PA requirements.

Prefixes indicating NIA Magellan radiology prior authorization: .AJB = ZCS. WSN; .AXG = ZCW. WSN; .BFR = ZCY. WSN; .BLA = ZCZ. WSN; .BLT (and others).
These prefixes represent fully insured and ASO groups but may not include all affected groups.
Check eligibility and benefits for each member to determine whether PA from NIA Magellan is required.

Key Terms

inv-05: NIA Magellan Healthcare — definition and role

VendorNational Imaging Associates (NIA) Magellan Healthcare, a subsidiary of Magellan Healthcare Inc., providing utilization management services on behalf of BlueCross BlueShield of South Carolina.

RolePerforms prior authorization (PA) review for certain outpatient advanced imaging and radiology services (e.g., MRI, MRA, CT, PET) on behalf of the payer.

ScopeApplies to PA requirements for certain fully insured members as identified by group prefixes listed in this document.

Relationship to PayerIndependent vendor contracted to act on behalf of BlueCross BlueShield of South Carolina for utilization management activities.

inv-06: Group Prefixes — meaning and limitations

What prefixes representEmployer/group billing prefixes that identify groups for which PA via NIA Magellan is required.

Membership typesPrefixes represent both fully insured and Administrative Services Only (ASO) groups.

Scope limitationList of prefixes may not be exhaustive — always verify member benefits to confirm PA requirements.

When to useIf a member's group prefix matches one listed, PA is required for advanced outpatient radiology services (MRI, MRA, CT, PET, etc.).

OpenPayer

NIA Magellan Radiology Prior Authorization Group Prefixes

When Prior Authorization Applies

Imaging Types and Codes Referenced

Actions Providers Must Take

Key Terms

MRI	MRI
MRA	MRA
CT	CT
PET	PET
Other advanced radiology services	Other advanced radiology services