Ambetter from Sunshine Health expands partnership with National Imaging Associates
Date: 11/23/20
Fort Lauderdale, Florida
Ambetter from Sunshine Health is pleased to announce we are expanding our partnership with National Imaging Associates, Inc. (NIA) to provide utilization management for outpatient rehabilitative and habilitative physical medicine services.
NIA currently manages our radiology benefit management program for outpatient advanced imaging services. NIA manages non-emergent outpatient imaging procedures for Ambetter from Sunshine Health membership through NIA’s Free-Standing Imaging Facilities coupled with Ambetter from Sunshine Health in-office providers and hospitals.
Starting Jan. 1, 2021, under terms of the agreement between NIA and Ambetter from Sunshine Health, the health plan will oversee the physical medicine program and be responsible for claims adjudication and medical policies. NIA will manage outpatient rehabilitative and habilitative services (physical, occupational and speech therapy services).
This program includes prior authorization for physical medicine services for Ambetter from Sunshine Health members only. The program is consistent with industrywide efforts to ensure that physical medicine services are consistent with nationally recognized clinical guidelines.
Physical, occupational and speech therapy services provided on or after Jan. 1, 2021, will require prior authorization.
Prior authorization will be available Dec. 14, 2020, for dates of service on or beyond Jan. 1, 2021. Providers can obtain authorizations at www.RadMD.com or from NIA’s call center at 1-800-424-4909.
You will receive more information from NIA in the coming weeks, including details about training. We appreciate your support and look forward to your assistance to ensure that Ambetter from Sunshine Health members receive quality and appropriate physical, occupational and speech therapy services.
Should you have questions, please contact Ambetter from Sunshine Health Provider Services at 1-877-687-1169.