NOTE: Within five days before the actual date of service, providers MUST confirm with Blue Shield that the member's health plan coverage is still in effect.
Blue Shield reserves the right to revoke authorizations prior to services being rendered based on cancellation of the member's eligibility. Final determination of benefits will be made after review of the claim for limitations or exclusions.
The goal of this advanced imaging and spine and pain management program is to improve the quality, accountability, and cost of services to our members.
To accomplish this goal, NIA coordinates with referring providers to assure advanced imaging and spine and pain services are appropriate compared to national standard clinical protocols.
The following outpatient non-emergency advanced imaging examinations are reviewed by NIA:
The following services are not reviewed by NIA:
Authorization requests and status information can be obtained by calling the NIA telephone call center. Authorization status for a provider's patients can also be checked online at the NIA website. The website also provides additional information about NIA and its services.
Submit these forms when delivering patient care, including forms related to coordinating benefits, member grievances, and more.
View the list of medical services and procedures requiring medical necessity review and/or supplemental documentation before payment is made.
Learn about our medical policies, policy goals and our process for making coverage decisions.
Review reference procedure manuals and benefit guidelines.