Evolent (formerly National Imaging Associates) ― Diagnostic Imaging Services
AmeriHealth Caritas Pennsylvania Community HealthChoices has an agreement with Evolent (formerly National Imaging Services [NIA]) to manage diagnostic imaging services such as MR/CT/PET.
The program will require prior authorization from Evolent for nonemergent outpatient:
- CT/CTA
- CCTA
- MRI/MRA
- PET scan
- MUGA scan
- Myocardial perfusion imaging (MPI)
Providers can request prior authorization online or by calling Evolent at 1-800-424-5657.
The physician ordering the procedures noted above is responsible for obtaining prior authorization. The rendering facility must ensure that prior authorization was obtained.
We recommend that you develop a process to ensure that the appropriate authorization number(s) has been obtained. Payment to the ordering physician and rendering facility will be denied for procedures performed without necessary authorization.