QUEST Integration – HMSA’s Business Association with NIA

Original Effective Date:

10/01/2006

Current Effective Date:

01/01/2015

1. To ensure appropriate utilization 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 has contracted with National Imaging Associates, Inc. (NIA) to provide precertification services for outpatient advanced imaging.
2. 1. NIA is experienced in the field of radiology management and has a client base that includes several Blue Cross and Blue Shield Plans, Aetna, and Humana – covering more than 18 million lives.
   2. NIA is certified by both NCQA and URAC in utilization management.
   3. NIA is accredited by URAC for HIPAA privacy and security and holds NCQA’s Privacy Certification for Business Associates
3. Under the terms of the agreement, HMSA retains claims adjudication functions, as well as oversight of the program, including medical policies and procedures. NIA will be responsible for managing the precertification of all advanced imaging scans.
4. NIA has also provided clinical guidelines adapted to HMSA needs and specifications (see www.RADMD.com)

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