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STAR, STAR+PLUS* and CHIP Utilization Review for Outpatient Rehabilitative and Habilitative Therapy Services through National Imaging Associates Effective December 1, 2021

Date: 10/28/21

Superior HealthPlan previously provided notice of the planned delegation of utilization review to National Imaging Associates, Inc. (NIA) for outpatient physical, occupational, and speech therapy treatment services for Superior Medicaid (STAR, STAR+PLUS*) and CHIP members.

*Please note: Medicaid STAR+PLUS non-Home and Community Based Services (HCBS) Waiver members ONLY.

The effective date for the transition to NIA to perform utilization review for prior authorization requests for therapy treatment from contracted providers for Superior’s STAR, CHIP and STAR+PLUS* members has been extended to December 1, 2021. Beginning November 29, 2021, prior authorization requests can be submitted to NIA for therapy treatment proposed to be provided on or after December 1, 2021.

Prior authorization requests can be submitted electronically to NIA at www.RadMD.com, by calling 1-800-642-7554 or through faxing 1-800-784-6864.

 Please make note of the following details relative to NIA’s receipt of prior authorization requests:

  • Prior authorization submissions to NIA are for therapy treatment requests for STAR, CHIP and STAR+PLUS non-HCBS Waiver members ONLY.
  • Authorization requests for STAR+PLUS HCBS Waiver members, STAR Kids and STAR Health should continue to be directed to Superior on and after December 1, 2021.
  • Requests for prior authorization for therapy treatment services from a non-contracted Superior provider should continue to be directed to Superior on and after December 1, 2021.

Providers are encouraged to review the clinical policies that will be utilized by NIA in advance of the therapy utilization review. To access NIA’s therapy treatment clinical policies proposed for use by NIA’s utilization review, please visit NIA’s Clinical Medicine Clinical Guidelines webpage.

Training Opportunities

To learn more about NIA policies, procedures and the submission of prior authorization requests for therapy treatment on and after December 1, 2021, providers are encouraged to attend one of the upcoming training events below:

  • Wednesday, November 10, 2021 – (9:00AM – 10:00AM) – REGISTER HERE
  • Monday, November 15, 2021 – (12:00PM-1:00PM) – REGISTER HERE
  • Thursday, November 18, 2021 – (9:00AM-10:00AM) – REGISTER HERE
  • Tuesday, November 30, 2021 – (9:00AM-10:00AM) – REGISTER HERE

To find additional training opportunities, please visit the Superior Provider Training Calendar.

For questions related to this communications, please contact your assigned Account Manager.