HMSA’s Business Association with NIA

Effective October 16, 2006, HMSA contracted with National Imaging Associates (NIA) to provide precertification services for outpatient advanced imaging (MRI, CT, PET, MPI), to ensure appropriate use of advanced diagnostic imaging in cases where traditional imaging would provide sufficient diagnostic information to treat the member or where another study would be more appropriate based on the patient’s condition.

HMSA’s association with NIA, a subsidiary of Evolent Health as of January 1, 2023, has grown to include precertification services for other types of procedures. As of 2023, NIA manages the following utilization programs on HMSA’s behalf.

• Advanced Imaging
• Cardiac Services
• Interventional Pain Management
• Spine and Joint Surgery
• Physical Medicine (Physical Therapy, Occupational Therapy, and Chiropractic Services)

NIA is experienced in the utilization management for these fields and has a client base that includes several Blue Cross and Blue Shield Plans, Aetna, and Humana, covering more than 18 million lives. NIA Evolent is certified by NCQA for Utilization Management.

Under the terms of HMSA’s agreement with NIA Evolent , HMSA retains claims adjudication functions, as well as oversight of NIA Evolent’s utilization management program, including medical policies and procedures. NIA Evolent is responsible for managing the precertification of all advanced imaging scans.

NIA Evolent has also provided clinical guidelines adapted to HMSA’s needs and specifications (see radMD.com).

Revision History