Dean Health Plan works with National Imaging Associates (NIA) (also referred to as Magellan Healthcare) for review and authorization of our Musculoskeletal (MSK) Care Management Program. This includes prior authorization by the treating physician for non-emergent inpatient and outpatient musculoskeletal surgeries, specifically hip, knee, shoulder, lumbar, and cervical spine.
This program incorporates the following key components:
- The MSK Care Management Program applies to the following Dean Health Plan product lines:
- Commercial – Dean HMO
- Dean POS
- Dean PPO
- Dean Focus EPO
- Dean Administrative Services Only (ASO)
- Dean Advantage
- Dean BadgerCare Plus (Medicaid)
- NIA's MSK Care Management Program manages the medical necessity review for non-emergent inpatient and outpatient musculoskeletal surgeries through physician authorization, prior to performing the surgery.
- Members who require the services of a provider who is not a Dean Health Plan Network provider may require two authorizations. The initial authorization will need to be obtained for the use of the non-network provider via Dean Health Plan Utilization Management Department.
- Authorization for these procedures may be submitted through NIA's website www1.RadMD.com or the NIA's toll-free phone number at 866-307-9729.
- MSK surgeries included in this program are non-emergent hip, knee, shoulder, lumbar, and cervical spine surgeries. A list of current spine surgery and knee, hip, and shoulder surgery CPT codes can be found in the Additional MSK Resources section.
For questions, contact NIA's customer service representatives: 866-307-9729, available 7 a.m. - 7 p.m. CT, Monday - Friday.