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National Imaging Associates

Health Net has contracted with National Imaging Associates Inc. (NIA) for radiology benefit management.

The program includes management of non-emergent, high-tech, outpatient radiology services through prior authorization. This program is consistent with industry-wide efforts to ensure clinically appropriate quality of care and to manage the increasing utilization of these services.

Health Net oversees the NIA program and is responsible for claims adjudication.

For Commercial HMO/PPO/EPO/POS/HSP and Ambetter HMO/PPO, prior authorization is required for the following outpatient radiology procedures:

  • MPI
  • MUGA scan
  • PET scan

Key provision: Providers rendering the above services should verify that the necessary authorization has been obtained. Failure to do so may result in non-payment of your claim. A separate prior authorization number is required for each procedure ordered.

Prior authorization is not required through NIA for services performed in the emergency department, on an inpatient basis or in conjunction with a surgery. Prior authorization and/or notification of admission in those instances is required through the health plan. To obtain authorization through NIA or for more information, visit NIA website.  

Last Updated: 07/28/2023