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Updated Effective Date: Genetic and Molecular Testing - Delegation of Utilization Review to National Imaging Associates (NIA)

Date: 08/15/22

The effective date for planned delegation of utilization review to National Imaging Associates, Inc. (NIA) for genetic and molecular testing services has been delayed. Please review the following notice for details: Update: Genetic and Molecular Testing - Delegation of Utilization Review to National Imaging Associates (NIA)

Superior HealthPlan previously provided notice of the planned delegation of utilization review to National Imaging Associates, Inc. (NIA) for genetic and molecular testing services for Superior Medicaid (STAR, STAR+PLUS, STAR Health and STAR Kids), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Ambetter from Superior HealthPlan (Marketplace) and Wellcare By Allwell (HMO and HMO DSNP) members.

The effective date for the transition to NIA to perform utilization review for genetic and molecular testing has been extended to October 1, 2022. Beginning September 26, 2022, prior authorization requests can be submitted to NIA for tests performed on or after October 1, 2022.

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.

Providers are encouraged to review the clinical policies that will be utilized by NIA in advance of the genetic and molecular testing utilization review. To access NIA’s genetic testing clinical policies, please visit NIA’s Genetic Testing Clinical Guidelines webpage.

Training Opportunities

To learn more about NIA’s policies, procedures and the submission of prior authorization requests for genetic and molecular testing on or after October 1, 2022, providers are encouraged to attend one of the upcoming training events below:

  • Thursday, August 18, 2022 (12:00 p.m. – 1:00 p.m.): REGISTER NOW
  • Wednesday, August 24, 2022 (8:00 a.m. – 9:00 a.m.): REGISTER NOW
  • Tuesday, August 30, 2022 (8:00 a.m. – 9:00 a.m.): REGISTER NOW

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

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