MeridianHealth (Medicaid) and WellCare (Medicare) - NEW Authorization Vendor Change

February 25, 2021

 

Please see the attached fax notification that is going to be sent to offices regarding the prior authorization vendor change for MeridianHealth (Medicaid) and WellCare (Medicare). This change is going to go into place effective 4/1/21.

 

National Imaging Associates, Inc. (NIA)

  • www.RadMD.com
  • 1-866-842-1767 (Medicaid)
  • 1-800-424-5388 (Medicare)

 

As a reminder, for Ambetter members

This link will provide more information on Ambetter (Commercial) : https://www.ambettermeridian.com/provider-resources/manuals-and-forms/pre-auth.html

HealthHelp and eviCore will no longer be managing services for the Meridian plans migrating to Centene platform on 1/1/21. This includes the legacy Meridian HIX and MI MMP. Any services that do not fall within the scope of the Centene vendors (i.e. NIA, New Century) will be managed in house as they currently are. H3/Innovista will also no longer be managing the MI MMP membership effective 1/1/21, they will continue to manage H5475(DSNP/MAPD) membership.

Here is the information related to NIA, New Century, TurningPoint

As of January 1st 2021:

  MI MMP IL MMP MI HIX (Ambetter) Comments
NIA Rad / Card

Rad / Card

PT/OT/ST

Rad/ Card

PT/OT/ST

 

New Century

 

    Medical Oncology  
TurningPoint

Musculoskeletal Surg. Procedures

Musculoskeletal Surg. Procedures

  Note – TurningPoint does not currently manage services for the Meridian HIX plans but TurningPoint does support some of the Ambetter plans however not in Michigan.