NIA Services - Prior-Consultation: The Core Service

Physician prior-consultation is at the core of NIA's Radiology Benefits Management solution. The key element of this service is the NIA Call Center which provides an important link between ordering physicians, rendering imaging providers, and healthplans for the prior consultation of diagnostic imaging examinations.

To obtain consultation, the ordering physicians or their staffs simply call the Center to connect with experienced Call Center representatives, nurses, and board-certified physicians. Online consultation is also available via RadMD.

Key Call Center features:

• NIA operates two Call Centers - One in Rancho Cordova, California and a new state of the art facility in Phoenix, Arizona.
• NIA's Call Center received URAC accreditation in November 1998, 2000 and 2002 and NCQA Certification in July 2002
• The Center offers prior consultation for advanced imaging modalities, typically CT, MRI, MRA, Nuclear Cardiology, and PET scans

Quick Decisions

NIA's Call Center is staffed with experienced clinicians who have instant access to the latest information technologies and clinical algorithms. This technology provides the most efficient process for consultation and for registering procedures according to healthplan guidelines.

Within minutes, referring physicians or their clinical staffs can receive approval or are notified that the decision has been forwarded for consultation by a board-certified radiologist or physician. The application of advanced information systems, advanced clinical decision support algorithms, and telephone-based technologies results in unmatched call center efficiency:

NIA Algorithms Speed the Process

Our proprietary clinical algorithms are used to speed consultation in cases where a peer-to-peer dialogue is not indicated. They are...

• Created using the industry's largest database
• Supported by innovative technologies and proprietary software systems
• Tailored to client-specific needs, including benefit design and coverage issues
• Weighted for specialty entitlement
• Approved by each client's Chief Medical Officers
• Continually reviewed and refined

Peer-to-Peer Consultations by Expert Clinicians

In cases where authorization requests clinically indicate further consultation, physicians, if available, are transferred directly to one of NIA's board-certified radiologists or other physicians.

• Where requests are "denied," our radiologist reviewers recommend an appropriate alternative procedure
• No requests are ever denied without a concerted effort by NIA physicians to discuss the matter with the referring physician in peer-to-peer dialogue

Post-Consultation Guidance

Overall, this consultative dialogue enhances the member's quality of care and improves the administrative process while reducing the inappropriate over-utilization of diagnostic imaging services.

Steerage

When our professional consultation is complete, NIA further assists physicians or their staff in finding the most cost-effective, high-quality radiology facility closest to the patient's home.

• The steerage service leverages NIA's network development program which identifies, recontracts, tracks, and reevaluates high-quality yet economical imaging providers over time.
• As part of the consultation process, we can steer and schedule appropriate tests at facilities that meet the needs of patients and the cost-quality criteria of healthplan partners.
• There are varying levels of steerage available to meet healthplans' individual needs - from passive to more strict.

Click here for more information about the NIA Call Center.