Prior Authorization Updates for Medicare Advantage through NIA
Nov. 1, 2022
Coming soon, BlueCross BlueShield of South Carolina’s Medicare Advantage plans will require prior authorization for the following categories of services through National Imaging Associates (NIA):
- Radiation oncology
- Musculoskeletal
- Radiology
Prior authorization through NIA will include a clinical review for medical necessity using the following guidelines from the Centers for Medicare & Medicaid Services (CMS):
- National coverage determinations (NCD)
- Local coverage determinations (LCD)
- Local coverage articles (LCA)
- And other nationally accepted guidelines
For questions, please contact the Medicare Advantage team at 855-204-2744.
CMS is an independent organization that offers health information you might find helpful.
NIA is an independent company that provides utilization management on behalf of BlueCross BlueShield of South Carolina.