To facilitate the approval process, be sure you have the following information ready before logging on to RadMD.com or calling the NIA Magellan Utilization Management staff:
Note: Clinical information must be documented in the therapy treatment record and/or other medical record documentation, such as diagnostic imaging or testing reports, physician referral documentation. Handwritten notes on cover sheets, telephone calls or other fax pages not reflected in therapy treatment record or other objective documents will be noted—“handwritten note on cover sheet (telephone call, etc.) without confirmation in treatment record”—but will not constitute actionable information for clinical decision making. Be prepared to upload or fax medical records supporting the required information on the checklist.
Medical necessity determinations are based on NIA Magellan Guidelines (available on RadMD.com) and Apollo Managed Care clinical guidelines—comprehensive, evidenced-based healthcare review criterion (available upon request).