Skip to Main Content

On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.

On Feb. 21, 2024, Change Healthcare experienced a cyber security incident. Any individuals impacted by this incident will receive a letter in the mail. Learn more about this from Change Healthcare, or reach out to the contact center at 1-866-262-5342.

Genetic and Molecular Testing - Delegation of Utilization Review to National Imaging Associates (NIA)

Date: 06/03/22

Please Note: This article has been updated. Please review the following for updates: Updated Effective Date: Genetic and Molecular Testing - Delegation of Utilization Review to National Imaging Associates (NIA)

For service dates on and after September 1, 2022, utilization review for genetic and molecular testing services will be delegated to National Imaging Associates, Inc. (NIA) for Superior HealthPlan Medicaid (STAR, STAR+PLUS, STAR Health and STAR Kids), CHIP, STAR+PLUS Medicare-Medicaid Plan (MMP), Ambetter from Superior HealthPlan (Marketplace) and Wellcare by Allwell (HMO and HMO DSNP) members.

NIA will accept prior authorization requests for dates of service on or after September 1, 2022 from Superior in-network providers beginning August 23, 2022. Prior authorization may be requested using one of the following:

Prior authorization requests for genetic and molecular testing delivered by out-of-network providers should continue to be submitted to Superior.

CLINICAL POLICIES

NIA’s Genetic and Molecular Testing clinical guidelines for genetic and molecular testing services that will be utilized for services on and after September 1, 2022, can be found on NIA’s Genetic Testing Policies webpage. NIA’s clinical guidelines have been developed from practice experience, literature reviews, specialty criteria sets and empirical data.

TRAINING AND RESOURCES

Upcoming training opportunities for the NIA’s Genetic & Molecular Testing utilization review process and requirements are listed below:

  • Tuesday, August 2, 2022 (8:00 a.m. – 9:00 a.m.): REGISTER NOW
  • Wednesday, August 10, 2022 (12:00 p.m. – 1:00 p.m.): REGISTER NOW
  • Thursday, August 18, 2022 (12:00 p.m. – 1:00 p.m.): REGISTER NOW
  • Wednesday, August 24, 2022 (8:00 a.m. – 9:00 a.m.): REGISTER NOW
  • Tuesday, August 30, 2022 (8:00 a.m. – 9:00 a.m.): REGISTER NOW

To find additional training opportunities, please visit Superior’s Provider Training Calendar

CLAIMS

Superior will maintain responsibility for claims adjudication for genetic and molecular testing services on and after September 1, 2022. For additional information on how and where to submit claims, please reference the provider manuals found on Superior’s Provider Training and Manuals webpage.

For questions, please contact your local Account Manager.