Important Information Regarding Advanced Imaging, Cardiac, and Interventional Pain Management Service Authorizations

Date: 01/17/23

As Delaware’s newest Medicaid Managed Care Organization (MCO), we are committed to ensuring continuity of care for all our members who may have previously been enrolled with another MCO.

NIA Magellan Services is Delaware First Health’s vendor for advanced imaging, cardiac, and interventional pain management service utilization management. On behalf of DFH, NIA is waiving authorization requirements for our members through April 30, 2023, to support continuity of care. This grace period will also allow DFH providers time to familiarize themselves with NIA authorization guidelines. Beginning May 1st, NIA will enforce its normal guidelines.

During this grace period, providers will receive “Conditional Approval” letters from NIA for all requested services. This conditional approval will allow providers to continue treating DFH members as necessary in their current courses of treatment through April 30, 2023, as well as be reimbursed appropriately for those services. However, if the requested service would normally deny under NIA’s authorization requirements, these letters will outline those denial reasons even though authorization requirements are currently being waived. NIA’s provider portal at RadMD.com will also display these denial reasons. This is to help providers better understand NIA’s normal authorization requirements and guidelines.

We encourage you to continue rendering appropriate continuity of care services for DFH members during this grace period with confidence. We also strongly advise reviewing NIA’s authorization guidelines on RadMD.com for future service delivery.

For more information, visit both RadMD.com and DelawareFirstHealth.com, or call us at 1-877-236-1341.