Ambetter Outpatient Rehabilitative and Habilitative Therapy Services through NIA

Date: 11/02/20

Beginning January 1, 2021, Ambetter from Superior HealthPlan is pleased to announce we are expanding our partnership with National Imaging Associates, Inc. (NIA) to include utilization review of outpatient rehabilitative and habilitative therapy services on behalf of Ambetter. This program includes prior authorization for physical, occupational and speech therapy services for Ambetter members only.  Superior will continue to process claims.

Beginning December 14, 2020, prior authorization can be requested through NIA and will be required for any services scheduled to occur on or after January 1, 2021.  Authorizations can be obtained through www.RadMD.com.

Services requiring prior authorization include all of the following performed in an outpatient setting by in network providers:

• Physical therapy
• Occupational therapy
• Speech therapy

Providers will need to verify that the member’s therapy benefit has not been exhausted, prior to providing services, even if an “Approved Authorization” has been obtained. Member eligibility and benefits can be verified through Superior’s Secure Provider Portal or by calling Provider Services at 1-877-687-1196.

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

• Tuesdsay, December 15, 2020 – (8:00 AM – 9:00 AM) - REGISTER NOW
• Tuesdsay, December 15, 2020 – (12:00 PM – 1:00 PM) - REGISTER NOW
• Wednesday, January 6, 2021 – (8:00 AM – 9:00 AM) – REGISTER NOW
• Wednesday, January 6, 2021 – (12:00 PM – 1:00 PM) – REGISTER NOW

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

For additional information, please review:

• Prior Authorization Program for Physical Medicine Services Frequently Asked Questions (FAQ’s) (PDF)
• Prior Authorization Program for Physical Medicine Services Quick Reference Guide (QRG) (PDF)

For questions, please contact Provider Services at 1-877-687-1196.