Interventional Pain Management (IPM) Program: New Authorization Requirements Now Effective January 1, 2021

Date: 11/12/20

As a reminder, Superior HealthPlan, in partnership with National Imaging Associates (NIA), will implement a new Interventional Pain Management (IPM) program. This program is consistent with industry wide clinically appropriate quality of care standards to ensure appropriate utilization of resources for members ages 21 and older enrolled in Superior Medicaid (STAR, STAR+PLUS, STAR Health), STAR+PLUS Medicare-Medicaid Plan (MMP), Allwell from Superior HealthPlan (HMO and HMO SNP) and Ambetter from Superior HealthPlan (Marketplace).

The implementation date for this program has been delayed. Effective January 1, 2021, prior authorization will be required for non-emergent, outpatient IPM procedures and will apply to all Superior products for members age 21 and older.

The following outpatient procedures are included:

• Spinal Epidural Injections
• Paravertebral Facet Joint Injections or Blocks
• Paravertebral Facet Joint Denervation (Radiofrequency (RF) Neurolysis)
• Sacroiliac Joint Injections

Superior will manage the IPM program and will retain oversight of claims adjudication and medical policies. All procedures, outside of those listed above, will continue to be subject to Superior’s existing inpatient notification and authorization requirements.

Below is a list of upcoming provider training events for the NIA IPM program:

• Wednesday, December 16, 2020 (12:00 PM – 1:00 PM): REGISTER NOW
• Thursday, December 17, 2020 (8:00 AM – 9:00 AM): REGISTER NOW
• Tuesday, January 12, 2020 (12:00 PM – 1:00 PM): REGISTER NOW
• Wednesday, January 13, 2020 (8:00 AM – 9:00 AM): REGISTER NOW

Event details and additional training topics can be found on Superior’s Provider Training Calendar.

KEY PROVISIONS:

• The ordering physician is responsible for obtaining authorization prior to performing the IPM procedures outlined above.
• Providers may begin contacting NIA on December 21, 2020 to request prior authorization for procedures scheduled for dates of service on or after January 1, 2021.
• Prior authorization will not be required, for the IPM procedures listed above, when emergent or inpatient.

For additional information, please review the resources below:

• NIA: Interventional Pain Management Quick Reference Guide (QRG)
• NIA: Interventional Pain Management Frequently Asked Questions (FAQ)

Providers will receive additional information through provider training activities including:

• Provider announcements located on Superior’s Provider News and Information webpage and Superior’s Provider Newsflash.
• Updated provider manuals located on Superior’s Training and Manuals webpage.
• New provider education events (web-based) located on Superior’s Provider Training Calendar  

For questions, please contact your assigned Superior Account Manager.