Evolent (formerly National Imaging Associates)

Point32Health has a partnership with Evolent (formerly National Imaging Associates, Inc./NIA) to oversee prior authorization programs for certain services, including cardiac diagnostic tests and interventional procedures; high-tech diagnostic imaging (such as CT scans, PET scans, MRIs, etc.); select joint procedures (hip, knee, and shoulder surgery); spine surgery and cervical spine procedures; and outpatient interventional spine pain management services.

This applies for the following products: Harvard Pilgrim Health Care Commercial*, Harvard Pilgrim Health Care Stride (HMO/HMO-POS) Medicare Advantage, Tufts Health Plan Commercial**, Tufts Health Direct, Tufts Health Plan Together,  and Tufts Health Plan RITogether. For members of Tufts Health One Care, Evolent is utilized only for high-end diagnostic imaging prior authorization.

In addition, Evolent conducts utilization management for sleep studies for Harvard Pilgrim Health Care members only (for Tufts Health Plan members, refer to the eviCore vendor information).

You’ll find some resources and education materials for these programs — including utilization review matrices with coding — on Evolent’s dedicated webpages (for Harvard Pilgrim; for Tufts Health Plan commercial; for Tufts Health Public Plans).

To request prior authorization, contact Evolent online or by telephone.

Online: www.radmd.com

Telephone: 800-642-7543 for Harvard Pilgrim; 1-866-642-9703 forTufts Health Plan commercial; 800-207-4209 for Tufts Health Public Plans

Status and transaction numbers can be accessed through Evolent’s website at www.radmd.com. You can also verify authorizations through our secure portals, HPHConnect for Harvard Pilgrim members and the Tufts Health Plan secure portal for Tufts Health Plan members.

*for Harvard Pilgrim members, cardiac studies authorizations are not required for members under age 18. 

** The cardiac program does not apply for the US Family Health Plan.