Getting Started With NIA

Typically implementation of an NIA Radiology Benefits Management program takes 30 to 90 days. You will work with our very effective staff, including NIA’s Chief Medical Officer, Chief Clinical & Operations Officer, Vice Presidents of our Network and Call Center operations, along with our Chief Technology Officer, Reporting and Analysis Manager, and our Vice Presidents for Infrastructure & Facilities, and Utilization Management & Quality Compliance.

To ensure your Radiology Benefits Management system is properly tailored to the needs of your organization and is implemented with a minimum of disruption to your operations, we take the following approach:

Health Plan Contacts

We match up the NIA experts with the corresponding areas at the healthplan for the detailed dialogues during implementation.

• Project manager/health services contact
• Medical Director
• UM contact
• Provider relations contact
• Member services contact
• Compliance contact
• Claims configuration contact
• IT/telecom contact
• Data contact

Imaging Provider Relations – Program Start-Up

• Prepare communication pieces for network hospitals, free standing facilities, and physicians
• Conduct meetings with the healthplan’s UM, provider relations, member services, network operations, claims, marketing, and other affected departments
• Form imaging advisory committees and conduct ongoing meetings with large hospital systems and large physician practices to educate them on the program and reduce physician community push back
• Network development – establish access criteria for steerage

Information Requirements and Specific Implementation Activities

Information Technology

• Due diligence of client claims and information systems
• Receive and test data, including full member and provider files
• Review telecom needs
• Determine IT set up and processes – of claim, member, and provider files
• Determine processes for data transfer back to the healthplan
• Review monthly and quarterly reporting formats

Business Intelligence

• Conduct a day of in-house training for healthplan to teach NIA about idiosyncrasies of the plan
• Identify and address plan-specific business rules
• Discuss issues such as:
  • Par vs. non-par providers
  • Referral management
  • Benefit structure for diagnostic radiology services
  • National accounts

Utilization Management

• Review and approve UM / prior-consultation criteria
• Review & approve UM letters
• Establish imaging advisory committee
• Conduct HIPAA and legal planning

For more information contact Jay Youell, Senior Vice President of Health Plans and Insurance Markets by e-mail at djyouell@magellanhealth.com.